Complete 2013

Procedure Coding Updates

2012
AAPC
2480 South 3850 West, Suite B
Salt Lake City, Utah 84120
800-626-CODE (2633), Fax 801-236-2258
www.aapc.com
Complete 2013
Procedure
Coding Updates
Introduction

Disclaimer
This course was current when it was published. Every reasonable effort has been made to assure the accuracy of the infor-
mation within these pages. Readers are responsible to ensure they are using the codes, and following applicable guidelines,
correctly. AAPC employees, agents, and staff make no representation, warranty, or guarantee that this compilation of
information is error-free, and will bear no responsibility or liability for the results or consequences of the use of this course.
This guide is a general summary that explains guidelines and principles in profitable, efficient health care organizations.

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CPT copyright 2012 American Medical Association. All rights reserved.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part
of CPT, and the AMA is not recommendation their use. The AMA does not directly or indirectly practice medicine or
dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Anatomical Illustrations are provided by OptumInsight and are copyright 2012, OptumInsight, Inc.

Written by Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC and G.J. Verhovshek, MA, CPC

2012 AAPC
2480 South 3850 West, Suite B, Salt Lake City, Utah 84120
800-626-CODE (2633), Fax 801-236-2258, www.aapc.com
ISBN 978-1-937348-47-2

All rights reserved.

ii = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

Introduction
As technology and clinical knowledge evolve, so does the
practice of medicine. Health care also operates within a
complex, ever-changing regulatory environment. To keep
pace, the code sets we use to report medical services, proce-
dures, devices, and drugs must be updated regularly.
Each October, the American Medical Association releases
a revised CPT code set for implementation the following
January 1. At AAPC, our goal is to provide you with vital
information to make the implementation process easier.
This workbook summarizes significant CPT 2013 code
changes available at press time. Additional changes released
Checklist for Updating Your Codes
Begin reviewing 2013 CPT code changes, using this guide
Order 2013 code books
Review all changes to guidelines, notes, and instructions
in your book
Highlight changes in the books index pertinent to your
specialty, and review those changes
Highlight changes in the books tabular (numeric) section
pertinent to your specialty, and review those changes
Create a documentation cheat sheet of 2013 updates
that must be documented differently for coders to cap-
ture the information needed and distribute it to clinicians
Review and update superbills, chargemasters, etc.
Run utilization report of the deleted and revised codes
using your practice management systems.
Upload software change
Train coding and billing staff on changes
Check regularly for addenda or errata to the 2013 code
set; if addenda are issued, communicate the contents to
coding and clinical staff
Review physician quality reporting system (PQRS)
changes, if you are participating in PQRS, and educate
providers/make adjustments in processes to accommo-
date the new reporting measures
Communicate with payer/provider reps regarding
reimbursement and coverage issues
Archive last years books within three months of the new
code implementation dates
= FDA Approval Pending = Add-on
Introduction
subsequently, as addenda or errata, will be posted on the
AAPC website (www.aapc.com).
CPT 2013 contains revised section guidelines, parentheti-
cal references, and appendices. This guide summarizes
primarily revisions to the codes and code descriptors. Minor
changes in grammar or spelling that do not affect code use
may be omitted. This guide does not review in full all revi-
sions within CPT, and is not meant as a replacement for
the complete 2013 CPT codebook. Always use the most
current version of CPT, and carefully follow all CPT sec-
tion guidelines, parenthetical references, and other instruc-
tion when assigning codes.
CPT for 2013 Revisions
Section Guidelines
New section guidelines occur throughout CPT 2013.
New guidelines in the codebook are printed in green ink to
allow easy identification.
Modifiers
CPT 2013 contains no new modifiers; however, complete
descriptors for 16 modifiers in Appendix B have undergone
revisions to include other qualified health care profes-
sional language, to specify that these modifiers may be
appended to non-physician services.
All genetic testing code modifiers, previously listed in
CPT Appendix I, have been deleted. Genetic testing codes
83890-83914, to which the modifiers were applied, have
been deleted and replaced by new molecular pathology
codes 81200-81479.
Evaluation and Management
Services
CPT 2013 revises 82 evaluation and management codes
within the range 99201-99467 to specify that these E/M
services may be provided by a physician or other qualified
health care professional. Language suggesting that only
a physician may legitimately report such services has been
removed from the code descriptors.
For example, the revised descriptor for a level I, new
patient visit in the outpatient setting (99201) now specifies:
Complete 2013 Procedure Updates 1
Complete 2013 Procedure Coding Updates
Office or other outpatient visit for the evaluation and
management of a new patient, which requires these
3 key components:
A problem focused history;
A problem focused examination;
Straightforward medical decision making.
Counseling and/or coordination of care with other
physicians, other providers qualified health care
professionals, or agencies are provided consistent
with the nature of the problem(s) and the patients
and/or familys needs. Usually, the presenting
problem(s) are self-limited or minor. Physicians
typically spend Typically, 10 minutes are spent face-
to- face with the patient and/or family.
New text (underlined) clarifies that counseling and/or
coordination of care may be provided with other physi-
cians or other qualified health care professionals. Deleted
text (stricken) eliminates the reference to physician time,
thereby allowing, per AMA guidelines, that other, non-
physician providers may provide the service.
Descriptor changes throughout the E/M chapter are con-
sistent with this example. A summary of the affected codes
includes:
Outpatient visits: 9920199215
Observation: 9921799226
Inpatient care (initial and subsequent): 9922199233
Observation or initial hospital care: 9923499236
Office consultations: 9924199245
Inpatient consultations: 9925199255
Emergency department visits: 9928199285
Direction of emergency medical services: 99288
Nursing facility care (initial and subsequent): 99304
99310
Annual nursing facility assessment: 99318
Domiciliary or rest home visits: 9932499337
Home visits: 9934199350
Standby services: 99360
Supervision of patient care: 99374-99380
Telephone E/M services: 99441-99443
Online E/M services: 99444-99464
2 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
Critical care during interfacility transport, critically
ill or critically injured patient, 24 months of age or
younger: 9946699467.
E/M section guidelines also have been modified to allow
non-physician providers to report services. For example,
the descriptors for critical care services (9929199292,
9946899469, and 9947199476) have not been revised,
but section guidelines now stipulate, Critical care is the
direct delivery by a physician(s) or other qualified health
care professional of medical care for a critically ill or criti-
cally injured patient.
Revisions to include other qualified health care provid-
ers were made so that the type of provider (eg, physician,
nurse practitioners, physician assistants, outpatient hospital
facilities) does not dictate which codes may be reported.
CPT codes describe the services performed, not the
provider who performs the service. Each states scope-of-
practice laws determine the services an individual provider
is qualified to perform. Providers typically considered to
be other qualified health care professionals are advanced
registered nurse practitioners (ARNP)s, physician assistants
(PA)s, midwives, etc.
CPT 2013 also adds seven new codes in three new E/M
categories: Supervision by a control physician of interfacil-
ity transport care of the critically ill or critically injured
pediatric patient; Complex chronic care coordination ser-
vices, and; Transitional care management services.
E/M: Pediatric Critical Care Patient Transport
Subsection Guidance
New, time-based codes report the non face-to-face work
of a control physician directing care during interfacility
transport. The patients age and medical condition (criti-
cal illness or critical injury), and the total time, must be
documented. When determining time, do not include pre-
transport communication with the referring or accepting
facility. Only the time spent directly by the transport team
may be used to determine reportable time.
The controlling provider cannot code for any of the proce-
dures performed by the team performing the transport. Do
not report 99485 or 99486 with 99466 or 99467 for the
same patient.
= Service/Procedure Includes Moderate Sedation

# 99485 Supervision by a control physician of interfacility
transport care of the critically ill or critically injured pediatric
patient, 24 months of age or younger, includes two-way
communication with transport team before transport, at
the referring facility and during the transport, including data
interpretation and report; first 30 minutes
AAPC Rationale
Code 99485 describes the first 30 minutes of care. Do
not report 99485 for fewer than 15 minutes of care.
# 99486 Supervision by a control physician of inter-
facility transport care of the critically ill or critically injured
pediatric patient, 24 months of age or younger, includes two-
way communication with transport team before transport, at
the referring facility and during the transport, including data
interpretation and report; each additional 30 minutes (list
separately in addition to code for primary procedure)
AAPC Rationale
Report one unit of add-on code 99486 for each addi-
tional 30 minutes of supervision of transport care,
beyond the initial 30 minutes as reported with 99485.
E/M: Complex Chronic for performing complex chronic care coordination. The
Care Coordination Services
Subsection Guidance
A new E/M category reports coordination of care for
patients with chronic illnesses. Effective coordination of
services among providers to manage complex conditions
requires significant staff and provider time.
Patients with one or more chronic illnesses expected to
last at least 12 months, acute exacerbation of an illness, or
functional decline qualify for the use of these codes. The
coordination activities are detailed in the coding guidelines
preceding 9948799489.
Codes are reported per calendar month. At least one hour
must be documented to claim the services. Documenta-
tion templates to record the date, time spent on chronic
care coordination, and the care coordinated will facilitate
proper documentation to support the services.
Other CPT codes describe specific coordination or moni-
toring of care services not reported with 9948799489. For
example, end-stage renal disease services (9095190970)
cannot be reported during the same month as 99487
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
99489. The provider must determine which service type
required the most time, and report those codes. A paren-
thetical note following 99489 lists the services that cannot
be reported during the same month as 9948799489.
99487 Complex chronic care coordination services; first
hour of clinical staff time directed by a physician or other
qualified health care professional with no face-to-face visit, per
calendar month
AAPC Rationale
Code 99487 describes the first hour of clinical staff time
for performing complex chronic care coordination, when
there has been no face-to-face visit with the patient. The
code is reported per calendar month. The patients medical
condition must meet the requirements stated in the coding
guidelines preceding 9948799489.
99488 Complex chronic care coordination services; first
hour of clinical staff time directed by a physician or other quali-
fied health care professional with one face-to-face visit, per
calendar month
AAPC Rationale
Code 99488 describes the first hour of clinical staff time
patients medical condition must meet the requirements
stated in the coding guidelines preceding 9948799489.
This service includes one face-to-face encounter not sepa-
rately reported. Additional, medically necessary encounters
may be reported separately.
99489 Complex chronic care coordination services; each
additional 30 minutes of clinical staff time directed by a physician
or other qualified health care professional, per calendar month
(list separately in addition to code for primary procedure)
AAPC Rationale
Add-on code 99489 reports each additional 30 minutes of
complex chronic care coordination beyond the first hour,
to be reported in addition to 99487 or 99488.
E/M: Transitional Care Management Services
Subsection Guidance
A new E/M subsection reports transitional care manage-
ment for patients discharged from an inpatient hospital,
observation, or a skilled nursing facility. The goal of tran-
sitional care is to provide services needed to transition the
Complete 2013 Procedure Updates 3
Complete 2013 Procedure Coding Updates

patient from a facility to his or her home, domiciliary, rest

home, or assisted living. Such care helps to prevent read- Anesthesia
missions and lowers the cost of health care (outpatient care
is less expensive then inpatient care). Other Procedures
To qualify for these codes, the medical decision-making p 01991 Anesthesia for diagnostic or therapeutic nerve
must be of moderate to high complexity. The services blocks and injections (when block or injection is performed by
include one face-to-face visit and non face-to-face services a different provider physician or other qualified health care pro-
(eg, arranging home health agencies for patient care). fessional); other than the prone position
Coding guidelines preceding this subsection list the ser- AAPC Rationale
vices performed for transitional care. Codes are selected The code is revised to allow reporting by other qualified
based on medical decision-making associated with the health care professional (eg, certified registered nurse
patients condition, when the communication is initiated anesthetist (CRNA)).
with the patient, and when the face-to-face encounter
occurs following discharge. The first face-to-face encounter
is included. The codes may be reported only once per 30 p 01992 Anesthesia for diagnostic or therapeutic nerve
calendar days. blocks and injections (when block or injection is performed by
a different provider physician or other qualified health care pro-
fessional); prone position
99495 Transitional care management services with the
AAPC Rationale
following required elements: communication (direct contact,
The code is revised to allow reporting by other qualified
telephone, electronic) with the patient and/or caregiver within 2
health care professional (eg, certified registered nurse
business days of discharge medical decision making of at least
anesthetist (CRNA)).
moderate complexity during the service period face-to-face
visit, within 14 calendar days of discharge
AAPC Rationale Surgery
Report 99495 for transitional care management that
includes initial communication within two business days
Integumentary System/Repair (Closure):
of discharge, and a face-to-face encounter with 14 calendar Other Flaps and Grafts
days of discharge. Moderate or high complexity medical
decision-making is required. p 15740 Flap; island pedicle requiring identification and dis-
section of an anatomically named axial vessel
AAPC Rationale
99496 Transitional care management services with the
Code 15740 is revised to clarify the proper use of the
following required elements: communication (direct contact,
island pedicle flap. When performing flap procedures,
telephone, electronic) with the patient and/or caregiver within
small blood vessels may be included as the tissue is trans-
2 business days of discharge medical decision making of high
posed. An anatomically named axial vessel must be identi-
complexity during the service period face-to-face visit, within 7
fied and dissected as part of the pedicle flap procedure. See
calendar days of discharge
image on next page.
AAPC Rationale
Code 99496 is reported for transitional care management
that includes initial communication within two business
days of discharge, and a face-to-face encounter with seven
calendar days of discharge. High complexity medical deci-
sion-making is required. Because the patients condition
is more severe, the face-to-face encounter is expected to
happen sooner when reporting 99496 than with 99495.

4 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure Coding Updates

15740 Musculoskeletal System/Spine (Vertebral

Column): Arthrodesis
22586 Arthrodesis, pre-sacral interbody technique, including
disc space preparation, discectomy, with posterior instrumen-
tation, with image guidance, includes bone graft when per-
formed, L5-S1 interspace
AAPC Rationale
The new code has been created to report pre-sacral inter-
body technique arthrodesis with posterior instrumentation.
Code 22586 includes disc preparation, discectomy, poste-
rior instrumentation, imaging guidance, and bone graft.
Per CPT instructions, do not report 22586 with 20930-
20938, 22840, 22848, 72275, 77002, 77003, 77011, and
77012.

For pre-sacral interbody technique arthrodesis without

instrumentation, turn to Category III codes 0195T and
Anatomical Illustrations 2012, OptumInsight, Inc. 0196T.

22586
Musculoskeletal System/General:
Introduction or Removal
p 20665 Removal of tongs or halo applied by another
physician individual
AAPC Rationale
The term individual replaces physician in the code
descriptor, to allow a qualified health care provider other
than a physician to report the service.

Musculoskeletal System/Spine (Vertebral

Column): Vertebral Body, Embolization or
Injection
p 22522 Percutaneous vertebroplasty (bone biopsy
included when performed), 1 vertebral body, unilateral or bilat-
eral injection; each additional thoracic or lumbar vertebral body
(list separately in addition to code for primary procedure)
AAPC Rationale
Add-on code 22522 now includes conscious sedation, when
performed.

Anatomical Illustrations 2012, OptumInsight, Inc.

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 5

Complete 2013 Procedure Coding Updates
Musculoskeletal System/Shoulder: 24371 Revision of total elbow arthroplasty, including allograft
Repair, Revision, and/or Reconstruction
23473 Revision of total shoulder arthroplasty, including
allograft when performed; humeral or glenoid component
AAPC Rationale
Code 23473 has been added to report the revision of a
total shoulder arthroplasty with removal and replacement
of the artificial joint. Previously, two codes were reported
for this procedure: 23472 for the arthroplasty and either
23331 or 23332 for removal of the implant. The new code
includes the removal of the artificial joint and replacement
with a new joint.
Report 23473 when the procedure involves either a
humeral or glenoid component.
23474 Revision of total shoulder arthroplasty, including
allograft when performed; humeral and glenoid component
AAPC Rationale
Code 23474 has been added to report the revision of a
total shoulder arthroplasty with removal and replacement
of the artificial joint. Previously, two codes were reported
for this procedure: 23472 for the arthroplasty and either
23331 or 23332 for removal of the implant. The new code
includes the removal of the artificial joint and replacement
with a new joint.
Report 23474 when the procedure involves both a humeral
and glenoid component.
Musculoskeletal System/Humerus (Upper
Arm) and Elbow: Repair, Revision, and/or
Reconstruction
24370 Revision of total elbow arthroplasty, including allograft
when performed; humeral or ulnar component
AAPC Rationale
New code 24370 describes the revision of a total elbow
arthroplasty, which involves removal of the artificial joint
and replacement with a new joint. Previously, this proce-
dure was reported using two codes: 24363 for the total
elbow arthroplasty and 24160 for artificial joint removal.
The new code reports both services.
Report 24370 when the procedure involves either the
humeral or ulnar component.
6 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
when performed; humeral and ulnar component
AAPC Rationale
Code 24371 has been added to report the revision of a
total elbow arthroplasty, which involves removal of the
artificial joint and replacement with a new joint. Previ-
ously, this procedure was reported using two codes: 24363
for the total elbow arthroplasty and 24160 for artificial
joint removal. The new code reports both services.
Report 24371 when the procedure involves both a humeral
and ulnar component.
Musculoskeletal System/Foot and Toes:
Other Procedures
p 28890 Extracorporeal shock wave, high energy, performed
by a physician or other qualified health care professional,
requiring anesthesia other than local, including ultrasound guid-
ance, involving the plantar fascia
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 28890 has been amended to allow this ser-
vice to be performed by a physician or other qualified
health care professional.
Musculoskeletal System/Application of Casts
and Strapping: StrappingAny Age
29590 Denis-Browne splint strapping
AAPC Rationale
This procedure is no longer performed.
Respiratory System/Trachea
and Bronchi: Endoscopy
Subsection Guidance
New Category I codes replace deleted Category III codes
0250T0252T to report procedures performed for the
insertion and removal for bronchial valves. Bronchial
valves are inserted to treat patients with emphysema or
lung damage. Valves are inserted to limit airflow to the
damaged part of the lung to promote healing. There are a
total of five lobes in the lungs (two in the left lung, three
in the right).
= Service/Procedure Includes Moderate Sedation

31647 Bronchoscopy, rigid or flexible, including fluoro-
scopic guidance, when performed; with balloon occlusion, when
performed, assessment of air leak, airway sizing, and insertion
of bronchial valve(s), initial lobe
AAPC Rationale
Report 31647 for insertion of bronchial valve(s) in an initial
lobe. If performed in more than one lobe, report 31651
(below) for each additional lobe. Fluoroscopic guidance is
included and may not be separately reported.
31647
Anatomical Illustrations 2012, OptumInsight, Inc.
31648 Bronchoscopy, rigid or flexible, including fluoro-
scopic guidance, when performed; with removal of bronchial
valve(s), initial lobe
AAPC Rationale
Report 31648 for removal of bronchial valve(s) in an initial
lobe. If performed in more than one lobe, report 31649
(below) for each additional lobe. Fluoroscopic guidance is
included and may not be separately reported.
31649 Bronchoscopy, rigid or flexible, including fluoro-
scopic guidance, when performed; with removal of bronchial
valve(s), each additional lobe (list separately in addition to code
for primary procedure)
AAPC Rationale
Report 31648 (above) for removal of bronchial valve(s) in
an initial lobe. If performed in more than one lobe, report
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
add-on code 31649 for each additional lobe. Fluoroscopic
guidance is included and may not be separately reported.
31651 Bronchoscopy, rigid or flexible, including fluoro-
scopic guidance, when performed; with balloon occlusion, when
performed, assessment of air leak, airway sizing, and insertion
of bronchial valve(s), each additional lobe (list separately in
addition to code for primary procedure[s])
AAPC Rationale
Report 31647 (above) is reported for the insertion of bron-
chial valve(s) in an initial lobe. If performed in more than
one lobe, report add-on code 31651 for each additional
lobe. Fluoroscopic guidance is included and may not be
separately reported.
31656 Bronchoscopy, rigid or flexible, including fluoroscopic
guidance, when performed; with injection of contrast material
for segmental bronchography (fiberscope only)
AAPC Rationale
Bronchography is no longer performed. Computed Tomog-
raphy (CT) is the standard of care replacing bronchography.
Respiratory System/Trachea and Bronchi:
Bronchial Thermoplasty
Subsection Guidance
Category III codes 0276T0277T have been deleted and
replaced with new codes to report bronchial thermoplasty.
The procedure involves radiofrequency ablation to treat
asthmatic patients by reducing the muscle associated with
airway constriction.
31660 Bronchoscopy, rigid or flexible, including fluoro-
scopic guidance, when performed; with bronchial thermoplasty,
1 lobe
AAPC Rationale
Report 31660 for bronchial thermoplasty performed on
one lobe. The procedure includes fluoroscopic guidance.
31661 Bronchoscopy, rigid or flexible, including fluoro-
scopic guidance, when performed; with bronchial thermoplasty,
2 or more lobes
AAPC Rationale
Report 31661 for bronchial thermoplasty performed on
two or more lobes. The procedure includes fluoroscopic
guidance.
Complete 2013 Procedure Updates 7
Complete 2013 Procedure Coding Updates

Note that 31661 is not an add-on code: Select 31660 if the
procedure is performed on one lobe or 31661 if performed
on two or more lobes. Do not select 31660 and 31661 for
the same surgical session.
Respiratory System/Trachea and Bronchi:
Introduction
31715 Transtracheal injection for bronchography
AAPC Rationale
Bronchography is no longer performed. Computed tomogra-
phy (CT) is the standard of care replacing bronchography.
32554 Thoracentesis, needle or catheter, aspiration of the
pleural space; without imaging guidance
AAPC Rationale
New codes replace 32421 and 32422 to more accurately
describe procedures performed to aspirate fluid from the
pleural space. A needle or catheter is used to puncture
the pleural space and withdraw fluid. The new codes are
selected based on whether imaging guidance is performed.
When imaging guidance is not performed, report 32554.
32554

Respiratory System/Lungs and Pleura:

Removal
32420 Pneumocentesis, puncture of lung for aspiration
AAPC Rationale
This procedure is no longer performed. See instead 32405.

32421 Thoracentesis, puncture of pleural cavity for aspiration,

initial or subsequent
AAPC Rationale
Code 32421 has been deleted and replaced with new codes
32554 and 32555.

32422 Thoracentesis with insertion of tube, includes water

seal (eg, for pneumothorax), when performed (separate proce-
dure)
AAPC Rationale
Code 32422 has been deleted and replaced with new codes
32554 and 32555.

Respiratory System/Lungs and Pleura:

Introduction and Removal Anatomical Illustrations 2012, OptumInsight, Inc.

p 32551 Tube thoracostomy, includes water seal connec-

tion to drainage system (eg, for abscess, hemothorax, empy-
ema water seal), when performed, open (separate procedure)
AAPC Rationale
The description for 32551 was revised to clarify proper
use. This is an open procedure. The conditions (abscess,
hemothorax, etc.) were removed to describe the procedure
performed rather than the conditions treated.
32555 Thoracentesis, needle or catheter, aspiration of the
pleural space; with imaging guidance
AAPC Rationale
New codes replace 32421 and 32422 to more accurately
describe procedures performed to aspirate fluid from the
pleural space. A needle or catheter is used to puncture
the pleural space and withdraw fluid. The new codes are
selected based on whether imaging guidance is performed.

8 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

When imaging guidance is performed, report 32555. CPT
includes a parenthetical note instructing you not to report
imaging guidance separately.
32556 Pleural drainage, percutaneous, with insertion of
indwelling catheter; without imaging guidance
AAPC Rationale
New codes have been created to report the percutaneous
drainage of pleural fluid. Unlike thoracocentesis, a tube
or catheter is left in place to allow for drainage. Code
selection is based on whether imaging guidance is used. If
imaging guidance is not used, report 32556.
32557 Pleural drainage, percutaneous, with insertion of
indwelling catheter; with imaging guidance
AAPC Rationale
New codes have been created to report the percutaneous
drainage of pleural fluid. Unlike thoracocentesis, a tube or
catheter is left in place to allow for drainage. Code selec-
tion is based on whether imaging guidance is used. When
imaging guidance is used, report 32557. Do not report
imaging guidance separately.
Respiratory System/Lungs and Pleura: defibrillator, report 33225 with 33263 (dual lead system) or
Stereotactic Radiation Therapy
32701 Thoracic target(s) delineation for stereotactic body
radiation therapy (SRS/SBRT), (photon or particle beam), entire
course of treatment
AAPC Rationale
Stereotactic radiation therapy is a new subsection in CPT
that includes new guidelines for proper use. Thoracic
target delineation is performed to identify tumor bor-
ders, tumor volume, and tumor relationship to adjacent
anatomic structures. Delineation of the tumor allows the
radiation oncologist to properly plan and deliver radiation
treatments.
Code 32701 is not reported with the radiation treatment
codes (7742777499). According to the coding guidelines,
32701 may be reported only once per course of treatment,
not per session.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
Cardiovascular System/Heart and
Pericardium: Pacemaker or Pacing
Cardioverter-Defibrillator
p 33225 Insertion of pacing electrode, cardiac venous
system, for left ventricular pacing, at time of insertion of pacing
cardioverter- defibrillator or pacemaker pulse generator (includ-
ing eg, for upgrade to dual chamber system and pocket revi-
sion) (List separately in addition to code for primary procedure)
AAPC Rationale
The code descriptor was revised to remove pocket revi-
sion as a requirement, and parenthetical notes have been
added to instruct when it is appropriate to report 33225
with other procedures. When reporting with 33322 or
33323, claim 33225 only when pocket relocation is per-
formed.
The table for pacemaker and cardioverter-defibrillator ser-
vices also has been revised to indentify the proper codes
for the conversion of an existing bi-ventricular system and
removal and replacement of the pulse generator. When the
procedure is performed for a pacemaker, report 33225 with
33228 (dual lead system) or 33229 (multiple lead system).
When the procedure is performed for a cardioverter-
33264 (multiple lead system).
Cardiovascular System/Heart and Pericardium:
Heart (Including Valves) and Great Vessels
Subsection Guidance
Category III codes 0256T, 0258T, and 0259T have been
deleted and replaced with Category I codes 3336133369
to report transcatheter aortic valve replacement. TAVR
is a non-invasive procedure to replace the aortic valve for
patients with aortic stenosis (narrowing of the aortic valve).
New subsection guidelines provide instruction for proper
use of the new codes, and identify the services included:
Gaining access, deployment, and repositioning of the valve,
temporary pacemaker insertion for rapid pacing, closure of
arteriotomy, angiography, and radiologic supervision and
interpretation. A team of providers is required for this pro-
cedure (eg, cardiologist, interventional radiologists). When
two surgeons work together to perform these procedures,
append modifier 62.
Diagnostic coronary angiography may be reported sepa-
rately when a prior coronary angiography was not per-
Complete 2013 Procedure Updates 9
Complete 2013 Procedure Coding Updates
formed or, if a prior coronary angiography was performed,
the test is not adequate (eg, patients condition has changed
since the original angiography, the initial study is inad-
equate visualization of anatomy).
The new codes are selected based on whether the approach
is open or percutaneous and the vessel the surgeon uses for
the approach. Cardiopulmonary bypass is reported with
the appropriate add-on code (3336733369), depending on
the type of access performed.
33361 Transcatheter aortic valve replacement (TAVR/TAVI)
with prosthetic valve; percutaneous femoral artery approach
AAPC Rationale
Report 33361 for transcatheter aortic valve replacement
using a percutaneous approach through the femoral artery.
33362 Transcatheter aortic valve replacement (TAVR/TAVI)
with prosthetic valve; open femoral artery approach
AAPC Rationale
Report 33362 for transcatheter aortic valve replacement
using an open approach through the femoral artery.
33363 Transcatheter aortic valve replacement (TAVR/TAVI)
with prosthetic valve; open axillary artery approach
AAPC Rationale
Report 33363 for transcatheter aortic valve replacement
using an open approach through the axillary artery.
33364 Transcatheter aortic valve replacement (TAVR/TAVI)
with prosthetic valve; open iliac artery approach
AAPC Rationale
Report 33364 for transcatheter aortic valve replacement
using an open approach through the iliac artery.
33365 Transcatheter aortic valve replacement (TAVR/TAVI)
with prosthetic valve; transaortic approach (eg, median ster-
notomy, mediastinotomy)
AAPC Rationale
Report 33365 for transcatheter aortic valve replacement
using a transaortic approach. This is an open procedure
done via median sternotomy or mediastinotomy.
10 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
33367 Transcatheter aortic valve replacement (TAVR/
TAVI) with prosthetic valve; cardiopulmonary bypass support
with percutaneous peripheral arterial and venous cannulation
(eg, femoral vessels) (list separately in addition to code for pri-
mary procedure)
AAPC Rationale
Add-on codes have been created to report cardiopulmonary
bypass support when performed during a transcatheter
aortic valve replacement. The add-on codes are selected
based on whether the cannulation is performed percutane-
ously, open, or centrally.
Report 33367 when peripheral arterial and venous cannu-
lation is performed percutaneously.
33368 Transcatheter aortic valve replacement (TAVR/
TAVI) with prosthetic valve; cardiopulmonary bypass support
with open peripheral arterial and venous cannulation (eg, femo-
ral, iliac, axillary vessels) (list separately in addition to code for
primary procedure)
AAPC Rationale
Add-on codes have been created to report cardiopulmonary
bypass support when performed during a transcatheter
aortic valve replacement. The add-on codes are selected
based on whether the cannulation is performed percutane-
ously, open, or centrally.
Report 33368 when peripheral arterial and venous cannu-
lation is performed as an open procedure.
33369 Transcatheter aortic valve replacement (TAVR/
TAVI) with prosthetic valve; cardiopulmonary bypass support
with central arterial and venous cannulation (eg, aorta, right
atrium, pulmonary artery) (list separately in addition to code for
primary procedure)
AAPC Rationale
Add-on codes have been created to report cardiopulmonary
bypass support when performed during a transcatheter
aortic valve replacement. The add-on codes are selected
based on whether the cannulation is performed percutane-
ously, open, or centrally.
Report 33369 when peripheral arterial and venous can-
nulation is performed centrally through the aorta, right
atrium, or pulmonary artery.
= Service/Procedure Includes Moderate Sedation

Cardiovascular System/Heart 33993 Repositioning of percutaneous ventricular assist
and Pericardium: Cardiac Assist
Subsection Guidance
Category III codes 0048T and 0050T have been deleted
and replaced with new Category I codes 3399033993
for insertion, removal, and repositioning of percutaenous
ventricle assist devices. Ventricle assist devices assist the
patients heart to pump blood. The devices are used during
high-risk procedures or for critically ill patients. Ventricle
assist devices can be inserted percutaneously (33990
33991) or transthoracically (33975, 33976, 33979).
Coding guidelines have been added to the categories
of Heart (Including Valves) and Great Vessels, Cardiac
Valves, and Coronary Bypass procedures to direct you
to the correct codes when ventricular assist devices are
inserted.
33990 Insertion of ventricular assist device, percutaneous
including radiological supervision and interpretation; arterial
access only
AAPC Rationale
Report 33990 when the percutaneous ventricular assist
device (pVAD) involves arterial access only.
33991 Insertion of ventricular assist device, percutaneous
including radiological supervision and interpretation; both arte-
rial and venous access, with transseptal puncture
AAPC Rationale
Report 33991 when the percutaneous ventricular assist
device (pVAD) involves arterial and venous access and
transseptal puncture.
33992 Removal of percutaneous ventricular assist device
at separate and distinct session from insertion
AAPC Rationale
Report 33992 when the percutaneous ventricular assist
device (pVAD) is removed during a separate session.
Removal during the same session as the insertion is not
reported separately.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
device with imaging guidance at separate and distinct session
from insertion
AAPC Rationale
Report 33993 when the percutaneous ventricular assist
device (pVAD) is repositioned during a separate session.
Repositioning during the same session as the insertion is
not reported separately.
Imaging guidance is required to report this code.
Cardiovascular System/Heart and
Pericardium: Vascular Injection Procedures
p 36010 Introduction of catheter, superior or
inferior vena cava
AAPC Rationale
Introduction of catheter, to the superior or inferior vena
cava now includes conscious sedation, when performed.
p 36140 Introduction of needle or intracatheter;
extremity artery
AAPC Rationale
Introduction of a needle or intracatheter into an extremity
artery now includes conscious sedation, when performed.
Cardiovascular System/Arteries and Veins:
Vascular Injection Procedures
Subsection Guidance
The AMA/Specialty Society RVS Update Committee
(RUC) reviewed codes for carotid catheter procedures
because the codes were reported together more than 75
percent of the time. New codes have been created to pre-
vent duplicated services. The new codes report selective
and non-selective arterial catheter placement and angiog-
raphy in the aortic arch, and carotid and vertebral arteries.
They include vessel access, placement of catheter(s), con-
trast injection(s), fluoroscopy, radiological supervision and
interpretation, and closure of the arteriotomy.
The codes are unilateral; therefore, modifier 50 is appro-
priate if the service is performed bilaterally. CPT provides
specific instruction on appending modifier 59 for these
services.
New guidelines provide instruction for proper use of
3622136228. The codes are built on a hierarchy of ser-
Complete 2013 Procedure Updates 11
Complete 2013 Procedure Coding Updates

vices. When more than one procedure is performed on the
ipsilateral (same side) vessel, report only the most complex
procedure.
For example, a selective catheterization of the left common
carotid, including an angiography of the ipsilateral extra-
cranial circulation, is performed with a selective catheter-
ization of the right internal carotid artery. This would
be reported 36224, 36222-59. If both procedures were
performed on the left (same) side (left common carotid and
left internal carotid), you would report 36224 only.
Radiological supervision and interpretation is included
in codes 3622136228; however, if a 3D rendering is
performed, coding guidelines allow separate reporting
of 76376 or 76377. Likewise, if ultrasound guidance is
required to access the vessel, report 76937; and, 75774 may
be reported if the angiography is not performed for the
extracranial and intracranial cervicocerebral vessels (eg,
upper extremities).
phy of the extracranial carotid and cervicocerebral arch, when
performed
AAPC Rationale
Report 36223 for selective catheter placement in the
common carotid or innominate artery, including angiog-
raphy of ipsilateral (same side) intracranial carotid circula-
tion, the extracranial carotid, and the cervicocerebral arch.
36224 Selective catheter placement, internal carotid
artery, unilateral, with angiography of the ipsilateral intracranial
carotid circulation and all associated radiological supervision
and interpretation, includes angiography of the extracranial
carotid and cervicocerebral arch, when performed
AAPC Rationale
Report 36224 for selective catheter placement in the inter-
nal carotid artery, including angiography of ipsilateral
(same side) intracranial carotid circulation, the extracranial
carotid, and the cervicocerebral arch.

36224
36221 Non-selective catheter placement, thoracic aorta,
with angiography of the extracranial carotid, vertebral, and/or
intracranial vessels, unilateral or bilateral, and all associated
radiological supervision and interpretation, includes angiogra-
phy of the cervicocerebral arch, when performed
AAPC Rationale
Report 36221 for non-selective thoracic aorta catheter
placement. This procedure includes angiography of the
cervicocerebral arch. Do not report 36221 with 36222
36226.

36222 Selective catheter placement, common carotid or

innominate artery, unilateral, any approach, with angiography of
the ipsilateral extracranial carotid circulation and all associated
radiological supervision and interpretation, includes angiogra-
phy of the cervicocerebral arch, when performed
AAPC Rationale
Report 36222 for selective catheter placement in the
common carotid or innominate artery, including angiogra- Anatomical Illustrations 2012, OptumInsight, Inc.
phy of ipsilateral (same side) extracranial carotid circulation.

36225 Selective catheter placement, subclavian or innomi-

36223 Selective catheter placement, common carotid or nate artery, unilateral, with angiography of the ipsilateral verte-
innominate artery, unilateral, any approach, with angiography of bral circulation and all associated radiological supervision and
the ipsilateral intracranial carotid circulation and all associated interpretation, includes angiography of the cervicocerebral arch,
radiological supervision and interpretation, includes angiogra- when performed

12 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

AAPC Rationale
Report 36225 for selective catheter placement in the sub-
clavian artery. The procedure includes angiography of
ipsilateral (same side) vertebral circulation and of the cervi-
cocerebral arch.
36226 Selective catheter placement, vertebral artery, uni-
lateral, with angiography of the ipsilateral vertebral circulation
and all associated radiological supervision and interpretation,
includes angiography of the cervicocerebral arch, when per-
formed
AAPC Rationale
Report 36226 for selective catheter placement in the
vertebral artery. The procedure includes angiography of
ipsilateral (same side) vertebral circulation and of the cervi-
cocerebral arch.
36227 Selective catheter placement, external carotid
artery, unilateral, with angiography of the ipsilateral external
carotid circulation and all associated radiological supervision
and interpretation (list separately in addition to code for pri-
mary procedure)
AAPC Rationale
Report add-on code 36227 in addition to 36222, 36223,
or 36224 for selective catheter placement in the external
carotid artery.
36228 Selective catheter placement, each intracranial
branch of the internal carotid or vertebral arteries, unilateral,
with angiography of the selected vessel circulation and all asso-
ciated radiological supervision and interpretation (eg, middle
cerebral artery, posterior inferior cerebellar artery) (list sepa-
rately in addition to code for primary procedure)
AAPC Rationale
Report add-on code 36228 in addition 36224 or 36226
for selective catheter placement in each intracranial branch
of the internal carotid or vertebral arteries. Do not report
36228 more than twice, per side.
p 36400 Venipuncture, younger than age 3 years, necessitat-
ing physicians the skill of a physician or other qualified health
care professional, not to be used for routine venipuncture;
femoral or jugular vein
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 36400 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 36405 Venipuncture, younger than age 3 years, necessitat-
ing physicians the skill of a physician or other qualified health
care professional, not to be used for routine venipuncture;
scalp vein
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 36405 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 36406 Venipuncture, younger than age 3 years, necessitat-
ing physicians the skill of a physician or other qualified health
care professional, not to be used for routine venipuncture;
other vein
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 36406 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 36410 Venipuncture, age 3 years or older, necessitating
physicians the skill of a physician or other qualified health care
professional, for diagnostic or therapeutic purposes (not to be
used for routine venipuncture)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 36410 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Cardiovascular System/Arteries and Veins:
Transcatheter Procedures
37197 Transcatheter retrieval, percutaneous, of intravascular
foreign body (eg, fractured venous or arterial catheter), includes
radiological supervision and interpretation, and imaging guid-
ance (ultrasound or fluoroscopy), when performed
Complete 2013 Procedure Updates 13
Complete 2013 Procedure Coding Updates
AAPC Rationale
Code 37197 has been created to bundle radiological super-
vision and interpretation to percutaneous transcatheter
retrieval of a foreign body. The creation of the bundled
code resulted in the deletion of 37203. Report retrieval of
the vena cava filter with 37193.
37201 Transcatheter therapy, infusion for thrombolysis other
than coronary
AAPC Rationale
CPT 2013 deletes 37201 and adds new codes 37211
37214 that bundle the surgical and radiological supervision
and interpretation services. Radiology code 75896 has been
revised to remove mention of thrombolysis.
37203 Transcatheter retrieval, percutaneous, of intravascular
foreign body (eg, fractured venous or arterial catheter)
AAPC Rationale
Code 37203 has been deleted and replaced by 37197,
which bundles surgical and radiological supervision and
interpretation to percutaneous transcatheter retrieval of a
foreign body.
37209 Exchange of a previously placed intravascular catheter
during thrombolytic therapy
AAPC Rationale
Codes 37209 and 75900 have been deleted and replaced
by new codes 3721137214 that bundle surgical and radio-
logical supervision and interpretation services with infusion
thrombolysis.
Subsection Guidance
New codes bundle surgical and radiological supervision
and interpretation services with infusion thrombolysis
when performed in arterial and venous vessels. During
the procedure, chemicals are infused to break down clots.
Codes are selected for the initial treatment day. If the treat-
ment extends over more than one date of service, you may
use separate codes to report the subsequent treatment day
and the cessation or last treatment day.
37211 Transcatheter therapy, arterial infusion for throm-
bolysis other than coronary, any method, including radiological
supervision and interpretation, initial treatment day
14 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
AAPC Rationale
Report 37211 for infusion thrombolysis of an artery other
than coronary, once per day for the initial service.
37212 Transcatheter therapy, venous infusion for thromboly-
sis, any method, including radiological supervision and interpre-
tation, initial treatment day
AAPC Rationale
Report 37212 for infusion thrombolysis of a vein, once per
day for the initial service.
37213 Transcatheter therapy, arterial or venous infusion for
thrombolysis other than coronary, any method, including radio-
logical supervision and interpretation, continued treatment on
subsequent day during course of thrombolytic therapy, includ-
ing follow-up catheter contrast injection, position change, or
exchange, when performed;
AAPC Rationale
Report 37213 for infusion thrombolysis of an artery (other
than coronary) or vein on a subsequent day of therapy. You
would report this service only if the infusion thrombolysis
was initiated on a previous date of service. Position change
or exchange is included with the subsequent code.
# 37214 Transcatheter therapy, arterial or venous infu-
sion for thrombolysis other than coronary, any method,
including radiological supervision and interpretation, contin-
ued treatment on subsequent day during course of thrombo-
lytic therapy, including follow-up catheter contrast injection,
position change, or exchange, when performed; cessation of
thrombolysis including removal of catheter and vessel closure
by any method
AAPC Rationale
Report 37214 for the cessation of infusion thrombolysis
of an artery (other than coronary), including removal of
the catheter and closure of the vessel. Claim 37214 only
if the infusion thrombolysis was initiated on a previous
date of service. If the initiation and cessation are per-
formed on the same date of service, report either 37211
or 37212 only, depending on the type of vessel.
= Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure Coding Updates

Hemic and Lymphatic Systems: Transplantation Digestive System/Esophagus: Endoscopy

and Post-Transplantation Cellular Infusions
# 43206 Esophagoscopy, rigid or flexible; with optical
p 38240 Bone marrow or blood-derived peripheral stem endomicroscopy
Hematopoietic progenitor cell transplantation (HPC); allogeneic
transplantation per donor AAPC Rationale
Code 43206 has been created to describe esophagos-
AAPC Rationale copy performed with optical endomicroscopy. Opti-
Codes for HPC transplantation have been revised to assist cal endomicroscopy allows the provider to eliminate
with code selection. Allogenic transplantation means the random sampling and perform targeted biopsies through
recipient is not the donor. Because the procedure can real-time cellular observation of mucosal tissue. The
involve cells from more than one donor, the procedure is procedure is performed when the provider suspects
reported per donor. The procedure includes the physician preneoplastic diseases. Code 43026 includes moderate
monitoring physiological parameters, verification of cell sedation.
processing, patient evaluation, and direct supervision of the
infusion.
43206
p 38241 Bone marrow or blood-derived peripheral stem
Hematopoietic progenitor cell transplantation (HPC); autologous
transplantation
AAPC Rationale
Codes for HPC transplantation have been revised to assist
with code selection. Autologous transplantation means the
recipient and donor are the same person. The procedure
includes the physician monitoring physiological param-
eters, verification of cell processing, patient evaluation, and
direct supervision of the infusion.

# 38243 Hematopoietic progenitor cell (HPC); HPC boost

AAPC Rationale
A new code has been created to report HPC boost
which may occur days, months, or years from the origi-
nal HPC transplantation. The boost comes from the
original HPC donor from the initial transplantation.
This procedure is performed to treat a relapse or post-
transplant cytopenia (deficiency or lack of cellular ele-
ments in the circulating blood).

p 38242 allogenic Allogenic donor lymphocyte infusions

AAPC Rationale
With revisions to 38240 and 38241, 38242 is no longer a
child of parent code 38240. Report 38242 for lympho-
cyte infusions in patients who have had a previous bone
marrow transplant. Anatomical Illustrations 2012, OptumInsight, Inc.

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 15

Complete 2013 Procedure Coding Updates
43234 Upper gastrointestinal endoscopy, simple primary
examination (eg, with small diameter flexible endoscope) (sepa-
rate procedure)
AAPC Rationale
Upper gastrointestinal endoscopy with a small diameter
endoscope (43234) is now rarely performed. The most
common gastrointestinal endoscopy is 43235.
43252 Upper gastrointestinal endoscopy including esopha-
gus, stomach, and either the duodenum and/or jejunum as
appropriate; with optical endomicroscopy
AAPC Rationale
Code 43252 has been created to report upper gastrointes-
tinal endoscopy performed with optical endomicroscopy.
Optical endomicroscopy allows the provider to eliminate
random sampling and perform targeted biopsies through
real-time cellular observation of mucosal tissue. The proce-
dure is performed when the provider suspects preneoplastic
diseases. Code 43252 includes moderate sedation.
Digestive System/Intestines (Except Rectum):
Other Procedures
44705 Preparation of fecal microbiota for instillation, includ-
ing assessment of donor specimen
AAPC Rationale
Code 44705 has been created to report the preparation of
fecal microbiota for instillation in a patient with Clostrid-
ium difficile infection. Clostridium difficile (C. difficile) is a
bacterium commonly found in the intestines that can grow
out of control from use of antibiotics, which kill good
bacteria in the gut. The procedure includes collecting fecal
material from a donor, preparing the fecal material in a
slurry, and evaluating the material prior to instillation.
This service includes only the preparation prior to instilla-
tion, not the work to instill the fecal microbiota. A separate
code is reported for the instillation either through colo-
noscopy or sigmoidoscopy. A parenthetical note following
44705 instructs you to report 44799 for oro-nasogastric
tube or enema.
16 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
Urinary System/Bladder: Transurethral Surgery
52287 Cystourethroscopy, with injection(s) for chemodener-
vation of the bladder
AAPC Rationale
Code 52287 has been created to report injections for che-
modenervation of the bladder (eg, for neurogenic incon-
tinence).
Maternity Care and Delivery: Repair
p 59300 Episiotomy or vaginal repair, by other than attending
physician
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 59300 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation also may be reported by other (non-physi-
cian), qualified attending health care professionals.
Nervous System/Spine and Spinal Cord:
Reservoir/Pump Implantation
p 62370 Electronic analysis of programmable, implanted
pump for intrathecal or epidural drug infusion (includes evalua-
tion of reservoir status, alarm status, drug prescription status);
with reprogramming and refill (requiring skill physicians of a
physician or other qualified health care professional)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 62370 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Nervous System/Extracranial Nerves, Periph-
eral Nerves, and Autonomic Nervous System:
Neurostimulators (Peripheral Nerve)
p 64561 Percutaneous implantation of neurostimulator elec-
trode array; sacral nerve (transforaminal placement) including
image guidance, if performed
AAPC Rationale
Percutaneous implantation of neurostimulator electrode
array to the sacral nerve now includes image guidance,
when performed.
= Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure Coding Updates

Nervous System/Extracranial Nerves, Periph-
eral Nerves, and Autonomic Nervous System:
Destruction by Neurolytic Agent, Chemode-
nervation
p 64612 Chemodenervation of muscle(s); muscle(s) inner-
vated by facial nerve, unilateral (eg, for blepharospasm, hemifa-
cial spasm)
AAPC Rationale
The descriptor of 64612 was revised to add unilateral
to clarify proper code application. If the procedure is per-
formed bilaterally, append modifier 50.
p 64614 Chemodenervation of muscle(s); extremity(s) and/
or trunk muscle(s) (eg, for dystonia, cerebral palsy, multiple
sclerosis)
AAPC Rationale
Code 64614 was revised to specify extremity (singular).
Because the procedure includes chemodenervation of mul-
tiple muscles, it is reported once per session for extremity or
trunk muscles. Do not report 64614 with modifier 50.
65805 Paracentesis of anterior chamber of eye (separate pro-
cedure); with therapeutic release of aqueous
AAPC Rationale
To simplify code selection, 65805 has been deleted and
65800 (above) was revised to report removal of aqueous for
either diagnostic or therapeutic purposes.
#p 67810 Biopsy Incisional biopsy of eyelid skin including
lid margin
AAPC Rationale
Code 67810 was revised to include the anatomic site of
the eyelid and the depth of tissue removed. This code
is sometimes used in error when the proper integumen-
tary biopsy code should be reported. To report 67810,
the biopsy must be of the lid margin. Because this is an
incisional procedure, it was resequenced under the inci-
sional subsection instead of the excisional heading,
where it previously appeared.
Report 11100, 11101, or 11310-11313 for biopsy of the
skin of the eyelid.

64615 Chemodenervation of muscle(s); muscle(s) innervated

by facial, trigeminal, cervical spinal and accessory nerves, bilat-
eral (eg, for chronic migraine)
AAPC Rationale
Code 64615 has been created to report bilateral chemode-
nervation of muscles innervated by facial, trigeminal, cervi-
cal spine, and accessory nerves. This procedure typically
includes 31 injection sites to treat migraine headaches. The
procedure must be performed bilaterally and is valued as
such: Do not append modifier 50 to 64615. Do not report
64615 with 64612, 64613, or 64614.

Eye and Ocular Adnexa:

Anterior Segment Incision
p 65800 Paracentesis of anterior chamber of eye (separate
procedure); with diagnostic aspiration removal of aqueous
AAPC Rationale
To simplify code selection, 65805 (below) has been deleted
and 65800 was revised to report removal of aqueous for
either diagnostic or therapeutic purposes.

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 17

Complete 2013 Procedure Coding Updates

67810 Diagnostic Radiology: Spine and Pelvis

A portion of a lesion or suspect
tissue is removed for analysis
p 72040 Radiologic examination, spine, cervical; 2 3 views or less
AAPC Rationale
Codes for radiology examination of the cervical spine have
been revised to include the number of views to accurately
capture the work performed. When three or fewer views
are performed, report 72040.

p 72050 Radiologic examination, spine, cervical; 4 minimum

or 5 views
AAPC Rationale
Codes for radiology examination of the cervical spine have
Lesion to been revised to include the number of views to accurately
be biopsied
capture the work performed. When four or five views are
performed, report 72050.

p 72052 Radiologic examination, spine, cervical; complete,

The incision may be repaired with sutures
including oblique and flexion and/ 6 or extension studies more
views
AAPC Rationale
Codes for radiology examination of the cervical spine have
been revised to include the number of views to accurately
capture the work performed. When six or more views are
performed, report 72052.

Anatomical Illustrations 2012, OptumInsight, Inc. Diagnostic Radiology/Vascular:

Aorta and Arteries
Radiology 75650 Angiography, cervicocerebral, catheter, including vessel
origin, radiological supervision and interpretation
Diagnostic Radiology: Chest
AAPC Rationale
71040 Bronchography, unilateral, radiological supervision and Code 75650 has been deleted. Refer to 3622136226.
interpretation
AAPC Rationale 75660 Angiography, external carotid, unilateral, selective,
Bronchography is no longer performed. Computed tomog- radiological supervision and interpretation
raphy (CT) is now the standard of care replacing bron-
chography. AAPC Rationale
Code 75660 has been deleted. Refer to 3622136226.

71060 Bronchography, bilateral, radiological supervision and

interpretation 75662 Angiography, external carotid, bilateral, selective, radio-
logical supervision and interpretation
AAPC Rationale
Bronchography is no longer performed. Computed tomog- AAPC Rationale
raphy (CT) is now the standard of care replacing bron- Code 75662 has been deleted. Refer to 36227.
chography.

18 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

75665 Angiography, carotid, cerebral, unilateral, radiological
supervision and interpretation
AAPC Rationale
Code 75665 has been deleted. Refer to 36223 and 36224.
75671 Angiography, carotid, cerebral, bilateral, radiological
supervision and interpretation
AAPC Rationale
Code 75671 has been deleted. Refer to 36223 and 36224.
75676 Angiography, carotid, cervical, unilateral, radiological
supervision and interpretation
AAPC Rationale
Code 75676 has been deleted. Refer to 3622236224.
75680 Angiography, carotid, cervical, bilateral, radiological
supervision and interpretation
AAPC Rationale
Code 75680 has been deleted. Refer to 3622236224.
75685 Angiography, vertebral, cervical, and/or intracranial,
radiological supervision and interpretation
AAPC Rationale
Code 75685 has been deleted. Refer to 3622536226.
Diagnostic Radiology, Vascular: descriptor for 76000 has been amended to allow that this
Transcatheter Procedures
p 75896 Transcatheter therapy, infusion, any method (eg,
thrombolysis other than for thrombolysis, radiological supervi-
sion and interpretation
AAPC Rationale
New codes (3721137214) have been created for infusion
thrombolysis. The new codes include radiological supervi-
sion and interpretation; therefore, 75896 was revised to
exclude thrombolysis.
p 75898 Angiography through existing catheter for follow-up
study for transcatheter therapy, embolization or infusion, other
than for thrombolysis
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
New codes (3721137214) have been created for infusion
thrombolysis. The new codes include radiological supervi-
sion and interpretation; therefore, 75898 was revised to
exclude thrombolysis.
75900 Exchange of a previously placed intravascular catheter
during thrombolytic therapy with contrast monitoring, radiologi-
cal supervision and interpretation
AAPC Rationale
New codes (3721137214) have been created for infusion
thrombolysis. The new codes include radiological supervi-
sion and interpretation; therefore, 75900 has been deleted.
75961 Transcatheter retrieval, percutaneous, of intravascular
foreign body (eg, fractured venous or arterial catheter), radio-
logical supervision and interpretation
AAPC Rationale
Code 75961 has been deleted and replaced by 37197.
Diagnostic Radiology: Other Procedures
p 76000 Fluoroscopy (separate procedure), up to 1 hour
physician or other qualified health care professional time, other
than 71023 or 71034 (eg, cardiac fluoroscopy)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
service may be performed by a physician or other quali-
fied health care professional.
p 76001 Fluoroscopy, physician or other qualified health care
professional time more than 1 hour, assisting a nonradiologic
physician or other qualified health care professional (eg, neph-
rostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 76001 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 76376 3D rendering with interpretation and reporting of
computed tomography, magnetic resonance imaging, ultra-
sound, or other tomographic modality with image postpro-
Complete 2013 Procedure Updates 19
Complete 2013 Procedure Coding Updates

cessing under concurrent supervision; not requiring image post-
processing on an independent workstation
AAPC Rationale
Code 76376 was revised to include image postprocessing
under concurrent supervision. The parenthetical note was
revised to list procedures not reported with 76376.
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 77051 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation also may be reported by other (non-physi-
cian) health care professionals.

p 77052 Computer-aided detection (computer algorithm

p 76377 3D rendering with interpretation and reporting
analysis of digital image data for lesion detection) with further
of computed tomography, magnetic resonance imaging,
physician review for interpretation, with or without digitization of
ultrasound, or other tomographic modality with image post-
film radiographic images; screening mammography (list sepa-
processing under concurrent supervision; requiring image post-
rately in addition to code for primary procedure)
processing on an independent workstation
AAPC Rationale
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
Code 76377 was revised to include image postprocessing
descriptor for 77052 has been amended to allow that, per
under concurrent supervision. The parenthetical note was
AMA guidelines, this service may be performed by a qual-
revised to list procedures not reported with 76377.
ified health care professional other than a physician.

Diagnostic Ultrasound: Extremities Bone and Joint Studies

p 76885 Ultrasound, infant hips, real time with imaging
p 77071 Manual application of stress performed by physician
documentation; dynamic (requiring physician or other qualified
or other qualified health care professional for joint radiography,
health care professional manipulation)
including contralateral joint if indicated
AAPC Rationale
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
Consistent with revisions throughout CPT 2013, the
descriptor for 76885 has been amended to allow that this
descriptor for 77071 has been amended to allow that this
service may be performed by a physician or other quali-
service may be performed by a physician or other quali-
fied health care professional.
fied health care professional.

p 76886 Ultrasound, infant hips, real time with imaging docu-
mentation; limited, static (not requiring physician or other quali-
fied health care professional manipulation)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 76886 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Breast, Mammography
p +77051 Computer-aided detection (computer algorithm
analysis of digital image data for lesion detection) with further
physician review for interpretation, with or without digitization of
film radiographic images; diagnostic mammography (list sepa-
rately in addition to code for primary procedure)
Nuclear Medicine/Diagnostic:
Endocrine System
78000 Thyroid uptake; single determination
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.
78001 Thyroid uptake; multiple determinations
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.
78003 Thyroid uptake; stimulation, suppression or discharge
(not including initial uptake studies)
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.

20 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

78006 Thyroid imaging, with uptake; single determination
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.
78007 Thyroid imaging, with uptake; multiple determinations
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.
78010 Thyroid imaging; only
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.
78011 Thyroid imaging; with vascular flow
AAPC Rationale
Codes 7800078011 have been deleted. See 7801278014.
78012 Thyroid uptake, single or multiple quantitative
measurement(s) (including stimulation, suppression, or dis-
charge, when performed)
AAPC Rationale
Codes 7800078011 have been deleted and new codes
have been created to consolidate services and more accu-
rately describe the types of thyroid nuclear medicine scans
performed. Code 78012 is performed to evaluate the func-
tion of the gland.
78013 Thyroid imaging (including vascular flow, when
performed);
AAPC Rationale
Codes 7800078011 have been deleted and new codes
have been created to consolidate services and more accu-
rately describe the types of thyroid nuclear medicine scans
performed. Code 78013 is performed to determine the size,
shape, and position of the thyroid gland.
78014 Thyroid imaging (including vascular flow, when
performed); with single or multiple uptake(s) quantitative
measurement(s) (including stimulation, suppression, or
discharge, when performed)
AAPC Rationale
Codes 7800078011 have been deleted and new codes
have been created to consolidate services and more accu-
rately describe the types of thyroid nuclear medicine scans
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
performed. Use 78014 when the services identified in
78012 and 78013 are performed during the same session.
p 78070 Parathyroid planar imaging (including subtraction,
when performed)
AAPC Rationale
Revisions were made to 78070 to more accurately describe
the procedure performed. New codes 7807178072 have
been added to report Single Photon Emission Computed
Tomography (SPECT) and SPECT/CT performed for
parathyroid planar imaging.
78071 Parathyroid planar imaging (including subtraction,
when performed); with tomographic (SPECT)
AAPC Rationale
Prior to the creation of 78071, no CPT code properly
described SPECT performed during parathyroid planar
imaging.
78072 Parathyroid planar imaging (including subtraction,
when performed); with tomographic (SPECT), and concurrently
acquired computed tomography (CT) for anatomical localization
AAPC Rationale
Prior to the creation of code 78072, no CPT code prop-
erly described SPECT/CT performed during parathyroid
planar imaging.
Pathology and Laboratory
Molecular Pathology
Last year, CPT added a new subsection and 101 new
codes (8120081408) to the Pathology and Laboratory
chapter to describe molecular pathology procedures.
Molecular pathology is the study and diagnosis of disease
through the examination of nucleic acid (including DNA
and RNA), for the purposes of: detecting and monitoring
infectious agents; establishing clonality (cells descended
from and genetically identical to a single common ances-
tor), particularly for lymphoid diseases; assessing the pres-
ence of minimal residual disease for certain malignancies
following therapy; determining prognosis and/or predicting
response to therapy, and; testing for inherited diseases.
For 2013, CPT adds 13 new Tier 1 molecular pathology
procedure codes, as well as an unlisted molecular pathol-
ogy procedure code (81479), and revises the descriptors for
Complete 2013 Procedure Updates 21
Complete 2013 Procedure Coding Updates
all nine Tier 2 (8140081408) procedures. Because molec-
ular pathology procedures are highly specialized and infre-
quently reported, we will not cover these code revisions
and additions individually as part of this course. Consult
your 2013 CPT codebook for complete instructions and
parenthetical guidelines, definitions, and descriptors for
molecular pathology codes.
Molecular pathology instructions have been added to the
beginning of the CPT codebook. The information pro-
vides a history for the creation of the molecular pathology
codes, instructions for use, and frequently asked questions
to assist with proper code selection.
Multianalyte Assays with Algorithmic Analysis
(MAAA)
A new category, including coding guidelines, has been cre-
ated to report MAAA. MAAAs are algorithmic analysis
using the results of assays (molecular pathology assays,
fluorescent in situ hybridization assays, and nonnucleic
acid-based assays) and patient information, when appropri-
ate, to report a numeric score(s) or probability of develop-
ing specific conditions.
The code descriptions include the disease type, material
analyzed, number of markers, specimen type, algorithm,
and report.
81500 Oncology (ovarian), biochemical assays of two pro-
teins (CA-125 and HE4), utilizing serum, with menopausal
status, algorithm reported as a risk score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for ovarian cancer. Report 81500 when biochemical assays
of two proteins and menopausal status are used for the
algorithm.
81503 Oncology (ovarian), biochemical assays of five pro-
teins (CA-125, apoliproprotein A1, beta-2 microglobulin, trans-
ferrin, and pre-albumin), utilizing serum, algorithm reported as
a risk score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for ovarian cancer. Report 81503 for biochemical assays of
five proteins.
22 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
81506 Endocrinology (type 2 diabetes), biochemical assays
of seven analytes (glucose, HBA1C, insulin, HS-CRP, adopo-
nectin, ferritin, interleukin 2-receptor alpha), utilizing serum or
plasma, algorithm reporting a risk score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for type 2 diabetes via assays of the seven analytes listed
(glucose, HBA1C, insulin, HS-CRP, adoponectin, ferritin,
interleukin 2-receptor alpha).
81508 Fetal congenital abnormalities, biochemical assays
of two proteins (PAPP-A, HCG [any form]), utilizing maternal
serum, algorithm reported as a risk score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for fetal congenital abnormalities using biochemical assays
of two proteins.
81509 Fetal congenital abnormalities, biochemical assays of
three proteins (PAPP-A, HCG [any form], DIA), utilizing maternal
serum, algorithm reported as a risk score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for fetal congenital abnormalities using biochemical assays
of three proteins.
81510 Fetal congenital abnormalities, biochemical assays of
three analytes (AFP, UE3, HCG [any form]), utilizing maternal
serum, algorithm reported as a risk score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for fetal congenital abnormalities using biochemical assays
of three analytes.
81511 Fetal congenital abnormalities, biochemical assays of
four analytes (AFP, UE3, HCG [any form], DIA) utilizing mater-
nal serum, algorithm reported as a risk score (may include
additional results from previous biochemical testing)
AAPC Rationale
This new MAAA procedure is used to determine risk score
for fetal congenital abnormalities using biochemical assays
of four analytes.
= Service/Procedure Includes Moderate Sedation

81512 Fetal congenital abnormalities, biochemical assays
of five analytes (AFP, UE3, total HCG, hyperglycosylated HCG,
DIA) utilizing maternal serum, algorithm reported as a risk
score
AAPC Rationale
This new MAAA procedure is used to determine risk score
for fetal congenital abnormalities using biochemical assays
of five analytes.
81599 Unlisted multianalyte assay with algorithmic analysis
AAPC Rationale
An unlisted code has been created for MAAA tests when
a Category I code does not exist and there is no appropri-
ate code in Appendix O. Appendix O lists alphanumeric
codes that include four numeric digits followed by M.
Report codes in Appendix O by the proprietary name and
clinical lab or manufacturer. These codes are in an Appen-
dix because Category I codes report the service work and
cannot include proprietary names.
Chemistry
p 82009 Acetone or other ketone bodies Ketone body(s)
(eg, acetone, acetoacetic acid, serum beta-hydroxybutyrate);
qualitative
AAPC Rationale
Code 82009 was revised to reflect current clinical practice.
p 82010 Acetone or other ketone bodies Ketone body(s) (eg,
acetone, acetoacetic acid, serum beta-hydroxybutyrate); quan-
titative
AAPC Rationale
Code 82010 was revised to reflect current clinical practice.
82777 Galectin-3
AAPC Rationale
Code 82777 has been created to report measuring of galec-
tin-3, which can be used to assess the prognosis of heart
failure patients.
83890 Molecular diagnostics; molecular isolation or extraction,
each nucleic acid type (ie, DNA or RNA)
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 81200-81479.
83891 Molecular diagnostics; isolation or extraction of highly
purified nucleic acid, each nucleic acid type (ie, DNA or RNA)
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83892 Molecular diagnostics; enzymatic digestion, each
enzyme treatment
AAPC Rationale
Codes 8389083914 have been deleted. To report, refer to
molecular pathology codes 8120081479.
83893 Molecular diagnostics; dot/slot blot production, each
nucleic acid preparation
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83894 Molecular diagnostics; separation by gel electrophoresis
(eg, agarose, polyacrylamide), each nucleic acid preparation
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83896 Molecular diagnostics; nucleic acid probe, each
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83897 Molecular diagnostics; nucleic acid transfer (eg, South-
ern, Northern), each nucleic acid preparation
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83898 Molecular diagnostics; amplification, target, each
nucleic acid sequence
Complete 2013 Procedure Updates 23
Complete 2013 Procedure Coding Updates
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83900 Molecular diagnostics; amplification, target, multiplex,
first 2 nucleic acid sequences
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83901 Molecular diagnostics; amplification, target, multiplex,
each additional nucleic acid sequence beyond 2 (List separately
in addition to code for primary procedure)
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83902 Molecular diagnostics; reverse transcription
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83903 Molecular diagnostics; mutation scanning, by physical
properties (eg, single strand conformational polymorphisms
[SSCP], heteroduplex, denaturing gradient gel electrophoresis
[DGGE], RNAase A), single segment, each
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83904 Molecular diagnostics; mutation identification by
sequencing, single segment, each segment
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83905 Molecular diagnostics; mutation identification by allele
specific transcription, single segment, each segment
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
24 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
83906 Molecular diagnostics; mutation identification by allele
specific translation, single segment, each segment
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83907 Molecular diagnostics; lysis of cells prior to nucleic acid
extraction (eg, stool specimens, paraffin embedded tissue),
each specimen
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83908 Molecular diagnostics; amplification, signal, each
nucleic acid sequence
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83909 Molecular diagnostics; separation and identification by
high resolution technique (eg, capillary electrophoresis), each
nucleic acid preparation
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83912 Molecular diagnostics; interpretation and report
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83913 Molecular diagnostics; RNA stabilization
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
83914 Mutation identification by enzymatic ligation or primer
extension, single segment, each segment (eg, oligonucleotide
ligation assay [OLA], single base chain extension [SBCE], or
allele-specific primer extension [ASPE])
AAPC Rationale
Codes 8389083914 have been deleted; refer to molecular
pathology codes 8120081479.
= Service/Procedure Includes Moderate Sedation

Immunology
Codes 0279T and 0280T have been deleted and replaced
with Category I codes to report testing for tumor cells
circulating in the blood. The test is used to determine
the prognosis for cancer patients.
# 86152 Cell enumeration using immunologic selection
and identification in fluid specimen (eg, circulating tumor
cells in blood);
AAPC Rationale
Code 86152 has been created to report the technical
component; the interpretation and report are reported
using 86153 (below). When the same provider performs
the test and interpretation and report, report both 86152
and 86153.
# 86153 Cell enumeration using immunologic selection and
identification in fluid specimen (eg, circulating tumor cells in
blood); physician interpretation and report, when required
AAPC Rationale
Code 86152 (above) has been created to report the
technical component; the interpretation and report are
reported using 86153. When the same provider performs
the test and interpretation and report, report both 86152
and 86153.
86711 Antibody; JC (John Cunningham) virus
AAPC Rationale
Code 86711 has been created to report the testing to detect
the John Cunningham virus, which causes progressive
multifocal leukoencephalopathy (PML), a rare but often
fatal condition that destroys myelin, a protective covering
of nerve cells in the brain.
Immunology: Tissue Typing
Subsection Guidance
New codes 8682886835 report testing for antibodies to
human leukocyte antigens (HLA). HLA typing identifies
the unique HLA antigens for an individual. Tests of HLA-
class I (A, B, C) and class II (DR, DQ, DP) are performed
for solid organ and bone marrow transplants.
86828 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
etry); qualitative assessment of the presence or absence of
antibody(ies) to HLA class I and class II HLA antigens
AAPC Rationale
Report 86828 for qualitative assessment for the presence
or absence of HLA class I and class II. A qualitative test
tells you if a particular substance (analyte) is present in the
specimen.
86829 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); qualitative assessment of the presence or absence of
antibody(ies) to HLA class I or class II HLA antigens
AAPC Rationale
Report 86829 for qualitative assessment for the presence
or absence of HLA class I or class II. A qualitative test
tells you if a particular substance (analyte) is present in the
specimen.
86830 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); antibody identification by qualitative panel using complete
HLA phenotypes, HLA class I
AAPC Rationale
Report 86830 for qualitative panel using HLA class I. A
qualitative test tells you if a particular substance (analyte)
is present in the specimen.
86831 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); antibody identification by qualitative panel using complete
HLA phenotypes, HLA class II
AAPC Rationale
Report 86831 for qualitative panel using HLA class II. A
qualitative test tells you if a particular substance (analyte)
is present in the specimen.
86832 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); high definition qualitative panel for identification of
antibody specificities (eg, individual antigen per bead methodol-
ogy), HLA class I
AAPC Rationale
Report 86832 for qualitative panel for identification of
antibody specificities for HLA class I. A qualitative test
tells you if a particular substance (analyte) is present in the
specimen.
Complete 2013 Procedure Updates 25
Complete 2013 Procedure Coding Updates
86833 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); high definition qualitative panel for identification of
antibody specificities (eg, individual antigen per bead methodol-
ogy), HLA class II
AAPC Rationale
Report 86833 for qualitative panel for identification of
antibody specificities for HLA class II.
86834 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); semi-quantitative panel (eg, titer), HLA class I
AAPC Rationale
Report 86834 for semi-quantitative panel for HLA class I.
86835 Antibody to human leukocyte antigens (HLA), solid
phase assays (eg, microspheres or beads, ELISA, flow cytom-
etry); semi-quantitative panel (eg, titer), HLA class II
AAPC Rationale
Report 86835 for semi-quantitative panel for HLA class II.
Microbiology
p 87498 Infectious agent detection by nucleic acid (DNA or
RNA); enterovirus, reverse transcription and amplified probe
technique
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
p 87521 Infectious agent detection by nucleic acid (DNA or
RNA); hepatitis C, reverse transcription and amplified probe
technique
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
p 87522 Infectious agent detection by nucleic acid (DNA or
RNA); hepatitis C, reverse transcription and quantification
26 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
p 87535 Infectious agent detection by nucleic acid (DNA or
RNA); HIV-1, reverse transcription and amplified probe technique
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
p 87536 Infectious agent detection by nucleic acid (DNA or
RNA); HIV-1, reverse transcription and quantification
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
p 87538 Infectious agent detection by nucleic acid (DNA or
RNA); HIV-2, reverse transcription and amplified probe technique
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
p 87539 Infectious agent detection by nucleic acid (DNA or
RNA); HIV-2, reverse transcription and quantification
AAPC Rationale
Codes 8749887539 have been revised to include reverse
transcription, which more accurately reports the proce-
dure performed.
87631 Infectious agent detection by nucleic acid (DNA or
RNA); respiratory virus (eg, adenovirus, influenza virus, coro-
navirus, metapneumovirus, parainfluenza virus, respiratory
syncytial virus, rhinovirus), multiplex reverse transcription and
amplified probe technique, multiple types or subtypes, 3-5
targets
AAPC Rationale
New codes 8763187633 have been created for the nucleic
acid tests performed to detect respiratory viruses. The
codes are selected based on the number of targets for the
test. Report 87631 for three to five targets.
= Service/Procedure Includes Moderate Sedation

87632 Infectious agent detection by nucleic acid (DNA or
RNA); respiratory virus (eg, adenovirus, influenza virus, coro-
navirus, metapneumovirus, parainfluenza virus, respiratory
syncytial virus, rhinovirus), multiplex reverse transcription and
amplified probe technique, multiple types or subtypes, 6-11
targets
AAPC Rationale
New codes 8763187633 have been created for the nucleic
acid tests performed to detect respiratory viruses. The
codes are selected based on the number of targets for the
test. Report 87632 for six to 11 targets.
87633 Infectious agent detection by nucleic acid (DNA or
RNA); respiratory virus (eg, adenovirus, influenza virus, coro-
navirus, metapneumovirus, parainfluenza virus, respiratory
syncytial virus, rhinovirus), multiplex reverse transcription and
amplified probe technique, multiple types or subtypes, 12-25
targets
AAPC Rationale
New codes 87631-87633 have been created for the nucleic
acid tests performed to detect respiratory viruses. The
codes are selected based on the number of targets for the
test. Report 87633 for 12 to 25 targets.
87910 Infectious agent genotype analysis by nucleic acid
(DNA or RNA); cytomegalovirus
AAPC Rationale
Code 87910 has been created to report genotype analysis
by nucleic acid for cytomegalovirus, which are herpes
viruses (eg, herpes simplex viruses, varicella-zoster virus,
Epstein-Barr virus)
p 87901 Infectious agent genotype analysis by nucleic acid
(DNA or RNA); HIV-1, reverse transcriptase and protease
regions
AAPC Rationale
Code 87901 has become a child code indexed to new
parent code of 87910. Code application is not affected by
this change.
87912 Infectious agent genotype analysis by nucleic acid
(DNA or RNA); hepatitis B virus
AAPC Rationale
New code 87912 describes genotype analysis by nucleic
acid for the hepatitis B virus.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
Surgical Pathology
88375 Optical endomicroscopic image(s), interpretation and
report, real-time or referred, each endoscopic session
AAPC Rationale
Code 88375 describes interpretation and report of opti-
mal endomicroscopic images obtained. The use of optical
endomicroscopic imaging allows for more precise biopsies.
Report this code only when performed by a provider (eg,
pathologist) other than the provider performing the endo-
scopic procedure. Do not report 88375 with 43206 or
43252.
88384 Array-based evaluation of multiple molecular probes; 11
through 50 probes
AAPC Rationale
Codes 8838488386 have been deleted. See molecular
pathology codes 8120081479.
88385 Array-based evaluation of multiple molecular probes; 51
through 250 probes
AAPC Rationale
Codes 8838488386 have been deleted. See molecular
pathology codes 81200-81479.
88386 Array-based evaluation of multiple molecular probes;
251 through 500 probes
AAPC Rationale
Codes 8838488386 have been deleted. See molecular
pathology codes 8120081479.
Medicine
Many codes in the Medicine section of CPT 2013 have
seen descriptor revisions similar to those found in E/M
chapter (and less frequently, throughout the Surgery and
Radiology chapters), which now specifically allow the
reporting of services by other, qualified non-physician
practitioners.
Other significant changes include new (replacement) codes
for psychotherapy; percutaneous angioplasty, atherectomy,
and stent placement; nerve conduction studies, and; intra-
operative monitoring.
Complete 2013 Procedure Updates 27
Complete 2013 Procedure Coding Updates
Immunization Administration p 90660 Influenza virus vaccine, trivalent, live, for intranasal use
for Vaccines/Toxoids
90653 Influenza vaccine, inactivated, subunit, adjuvanted,
for intramuscular use
AAPC Rationale
Code 90653 has been created to report the supply of adju-
vanted seasonal trivalent influenza vaccine. The product is
currently pending FDA approval.
p 90655 Influenza virus vaccine, trivalent, split virus, preser-
vative free, when administered to children 6-35 months of age,
for intramuscular use
AAPC Rationale
Codes 9065590660 have been revised to include tri-
valent. Trivalent means the vaccine includes three viral
strains.
p 90656 Influenza virus vaccine, trivalent, split virus, preser-
vative free, when administered to individuals 3 years and older,
for intramuscular use
AAPC Rationale
Codes 9065590660 have been revised to include tri-
valent. Trivalent means the vaccine includes three viral
strains.
p 90657 Influenza virus vaccine, trivalent, split virus, when
administered to children 6-35 months of age, for intramuscu-
lar use
AAPC Rationale
Codes 9065590660 have been revised to include tri-
valent. Trivalent means the vaccine includes three viral
strains.
p 90658 Influenza virus vaccine, trivalent, split virus, when
administered to individuals 3 years of age and older, for intra-
muscular use
AAPC Rationale
Codes 9065590660 have been revised to include tri-
valent. Trivalent means the vaccine includes three viral
strains.
28 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
AAPC Rationale
Codes 9065590660 have been revised to include tri-
valent. Trivalent means the vaccine includes three viral
strains.
90665 Lyme disease vaccine, adult dosage, for intramuscular use
AAPC Rationale
Code 90665 has been deleted: The indicated vaccine is no
longer available.
# 90672 Influenza virus vaccine, quadrivalent, live, for
intranasal use
AAPC Rationale
Code 90672 has been created to report quadrivalent
(four viral strains) influenza vaccine for intranasal use.
90701 Diphtheria, tetanus toxoids, and whole cell pertussis
vaccine (DTP), for intramuscular use
AAPC Rationale
Code 90701 has been deleted: The vaccine was removed
from the market due to safety concerns.
90718 Tetanus and diphtheria toxoids (Td) adsorbed when
administered to individuals 7 years or older, for intramuscular
use
AAPC Rationale
Code 90718 has been deleted to prevent confusion for Td
vaccine. All Td vaccines are preservative free (see 90714).
90739 Hepatitis B vaccine, adult dosage (2 dose sched-
ule), for intramuscular use
AAPC Rationale
Code 90739 has been created to report two dose schedule
for Hepatitis B vaccine. The vaccine is currently pending
FDA approval.
= Service/Procedure Includes Moderate Sedation

p 90746 Hepatitis B vaccine, adult dosage (3 dose schedule),
for intramuscular use
AAPC Rationale
Code 90746 was revised to specify three does schedule,
which distinguishes it from new two-dose schedule code
90739.
Psychiatry
The psychiatry category received a major overhaul with
creation of new codes and guidelines, as well as substantial
code deletions. The revised code set more accurately report
the services behavioral health providers now perform.
Psychiatry/Interactive Complexity
90785 Interactive complexity (list separately in addition to
the code for primary procedure)
AAPC Rationale
This is an add-on code reported for patients whose com-
munication factors complicate the delivery of psychiatric
services (eg, the patient is verbally underdeveloped, or
an emotional caregiver complicates the session with the
patient).
CPT includes a list of codes with which you may report
90785. Do not report 90785 with E/M services.
Psychiatry/Psychiatric Diagnostic Procedures
90791 Psychiatric diagnostic evaluation
AAPC Rationale
New codes 90791 and 90792 (below) replace deleted codes
90801 and 90802. Psychiatric diagnostic evaluation is an
assessment that includes obtaining a history, mental status,
and recommendations. The service may require speaking
with the family or other sources. Report 90791/90792 once
per day, but not on the same day as E/M services. If the
psychiatric diagnostic evaluation is performed without a
medical service, report 90791.
90792 Psychiatric diagnostic evaluation with medical services
AAPC Rationale
New codes 90791 (above) and 90792 replace deleted codes
90801 and 90802. Psychiatric diagnostic evaluation is an
assessment that includes obtaining a history, mental status,
and recommendations. The service may require speaking
with the family or other sources. Report 90791/90792 once
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
per day, but not on the same day as E/M services. If the
psychiatric diagnostic evaluation is performed on the same
date as a medical service, report 90792.
90801 Psychiatric diagnostic interview examination
AAPC Rationale
Codes 90801 and 90802 have been deleted and replaced
with 90791 and 90792.
90802 Interactive psychiatric diagnostic interview examination
using play equipment, physical devices, language interpreter, or
other mechanisms of communication
AAPC Rationale
Codes 90801 and 90802 have been deleted and replaced
with 90791 and 90792.
90804 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an office or outpatient facility,
approximately 20 to 30 minutes face-to-face with the patient
AAPC Rationale
Codes 90804, 90805, 90806, 90808, and 90809 have
been deleted. See new codes 9083290838.
90805 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an office or outpatient facility,
approximately 20 to 30 minutes face-to-face with the patient;
with medical evaluation and management services
AAPC Rationale
Codes 90804, 90805, 90806, 90808, and 90809 have
been deleted. See new codes 9083290838.
90806 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an office or outpatient facility,
approximately 45 to 50 minutes face-to-face with the patient
AAPC Rationale
Codes 90804, 90805, 90806, 90808, and 90809 have
been deleted. See new codes 9083290838.
Complete 2013 Procedure Updates 29
Complete 2013 Procedure Coding Updates
90807 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an office or outpatient facility,
approximately 45 to 50 minutes face-to-face with the patient;
with medical evaluation and management services
AAPC Rationale
Codes 90804, 90805, 90806, 90808, and 90809 have been
deleted. See new codes 9083290838.
90808 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an office or outpatient facility,
approximately 75 to 80 minutes face-to-face with the patient
AAPC Rationale
Codes 90804, 90805, 90806, 90808, and 90809 have been
deleted. See new codes 9083290838.
90809 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an office or outpatient facility,
approximately 75 to 80 minutes face-to-face with the patient;
with medical evaluation and management services
AAPC Rationale
Codes 90804, 90805, 90806, 90808, and 90809 have been
deleted. See new codes 9083290838.
90810 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an office or outpatient
facility, approximately 20 to 30 minutes face-to-face with the
patient
AAPC Rationale
Codes 90810, 90811, 90812, 90813, 90814, and 90815
have been deleted. See 9083290838.
90811 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an office or outpatient
facility, approximately 20 to 30 minutes face-to-face with the
patient; with medical evaluation and management services
AAPC Rationale
Codes 90810, 90811, 90812, 90813, 90814, and 90815
have been deleted. See 9083290838.
30 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
90812 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an office or outpatient
facility, approximately 45 to 50 minutes face-to-face with the
patient
AAPC Rationale
Codes 90810, 90811, 90812, 90813, 90814, and 90815
have been deleted. See 9083290838.
90813 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an office or outpatient
facility, approximately 45 to 50 minutes face-to-face with the
patient; with medical evaluation and management services
AAPC Rationale
Codes 90810, 90811, 90812, 90813, 90814, and 90815
have been deleted. See 9083290838.
90814 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an office or outpatient
facility, approximately 75 to 80 minutes face-to-face with the
patient
AAPC Rationale
Codes 90810, 90811, 90812, 90813, 90814, and 90815
have been deleted. See 9083290838.
90815 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an office or outpatient
facility, approximately 75 to 80 minutes face-to-face with the
patient; with medical evaluation and management services
AAPC Rationale
Codes 90810, 90811, 90812, 90813, 90814, and 90815
have been deleted. See 9083290838.
90816 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an inpatient hospital, partial
hospital or residential care setting, approximately 20 to 30 min-
utes face-to-face with the patient
AAPC Rationale
Codes 90816, 90817, 90818, 90819, 90821, and 90822
have been deleted. See 9083290838.
= Service/Procedure Includes Moderate Sedation

90817 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an inpatient hospital, partial
hospital or residential care setting, approximately 20 to 30 min-
utes face-to-face with the patient; with medical evaluation and
management services
AAPC Rationale
Codes 90816, 90817, 90818, 90819, 90821, and 90822
have been deleted. See 9083290838.
90818 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an inpatient hospital, partial
hospital or residential care setting, approximately 45 to 50 min-
utes face-to-face with the patient
AAPC Rationale
Codes 90816, 90817, 90818, 90819, 90821, and 90822
have been deleted. See 9083290838.
90819 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an inpatient hospital, partial
hospital or residential care setting, approximately 45 to 50 min-
utes face-to-face with the patient; with medical evaluation and
management services
AAPC Rationale
Codes 90816, 90817, 90818, 90819, 90821, and 90822
have been deleted. See 9083290838.
90821 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an inpatient hospital, partial
hospital or residential care setting, approximately 75 to 80 min-
utes face-to-face with the patient
AAPC Rationale
Codes 90816, 90817, 90818, 90819, 90821, and 90822
have been deleted. See 9083290838.
90822 Individual psychotherapy, insight oriented, behavior
modifying and/or supportive, in an inpatient hospital, partial
hospital or residential care setting, approximately 75 to 80 min-
utes face-to-face with the patient; with medical evaluation and
management services
AAPC Rationale
Codes 90816, 90817, 90818, 90819, 90821, and 90822
have been deleted. See 9083290838.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
90823 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an inpatient hospital,
partial hospital or residential care setting, approximately 20 to
30 minutes face-to-face with the patient
AAPC Rationale
Codes 90823, 90824, 90826, 90827, 90828, and 90829
have been deleted. Refer to 9083290838.
90824 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an inpatient hospital,
partial hospital or residential care setting, approximately 20 to
30 minutes face-to-face with the patient; with medical evalua-
tion and management services
AAPC Rationale
Codes 90823, 90824, 90826, 90827, 90828, and 90829
have been deleted. Refer to 9083290838.
90826 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an inpatient hospital,
partial hospital or residential care setting, approximately 45 to
50 minutes face-to-face with the patient
AAPC Rationale
Codes 90823, 90824, 90826, 90827, 90828, and 90829
have been deleted. Refer to 9083290838.
90827 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an inpatient hospital,
partial hospital or residential care setting, approximately 45 to
50 minutes face-to-face with the patient; with medical evalua-
tion and management services
AAPC Rationale
Codes 90823, 90824, 90826, 90827, 90828, and 90829
have been deleted. Refer to 9083290838.
Complete 2013 Procedure Updates 31
Complete 2013 Procedure Coding Updates
90828 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an inpatient hospital,
partial hospital or residential care setting, approximately 75 to
80 minutes face-to-face with the patient
AAPC Rationale
Codes 90823, 90824, 90826, 90827, 90828, and 90829
have been deleted. Refer to 9083290838.
90829 Individual psychotherapy, interactive, using play equip-
ment, physical devices, language interpreter, or other mecha-
nisms of non-verbal communication, in an inpatient hospital,
partial hospital or residential care setting, approximately 75 to
80 minutes face-to-face with the patient; with medical evalua-
tion and management services
AAPC Rationale
Codes 90823, 90824, 90826, 90827, 90828, and 90829
have been deleted. Refer to 9083290838.
Psychiatry/Psychiatric Diagnostic Procedures:
Psychotherapy
Subsection Guidance
Psychotherapy is the treatment of mental illness and behav-
ioral disturbances, including therapeutic communication
to help the patient with emotional disturbances, adjust
behaviors, and encourage personal growth. New, time-
based codes simplify psychotherapy services reporting.
Add-on codes have been created to report psychotherapy
with an appropriate E/M code if a significant and sepa-
rately identifiable evaluation and management is per-
formed. Do not include time spent performing the E/M
service as part of the psychotherapy service.
90832 Psychotherapy, 30 minutes with patient and/or family
member
AAPC Rationale
Report 90832 for 16-37 minutes of psychotherapy. The
time must be face-to-face with the patient and/or family.
32 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
90833 Psychotherapy, 30 minutes with patient and/
or family member when performed with an evaluation and
management service (list separately in addition to the code for
primary procedure)
AAPC Rationale
Report 90833 when 16-37 minutes of psychotherapy is
provided on the same date as an E/M service. The time
must be face-to-face with the patient and/or family. Do not
include time spent performing the E/M service as part of
the psychotherapy service. Select the appropriate E/M code
based on the documentation.
90834 Psychotherapy, 45 minutes with patient and/or family
member
AAPC Rationale
Report 90834 for 38-52 minutes of psychotherapy. The
time must be face-to-face with the patient and/or family.
90836 Psychotherapy, 45 minutes with patient and/
or family member when performed with an evaluation and
management service (list separately in addition to the code for
primary procedure)
AAPC Rationale
Report 90836 when 38-52 minutes of psychotherapy is
provided on the same date as an E/M service. The time
must be face-to-face with the patient and/or family. Do not
include time spent performing the E/M service as part of
the psychotherapy service. Select the appropriate E/M code
based on the documentation.
90837 Psychotherapy, 60 minutes with patient and/or family
member
AAPC Rationale
Report 90837 for 53 or more minutes of psychotherapy.
The time must be face-to-face with the patient and/or
family.
90838 Psychotherapy, 60 minutes with patient and/
or family member when performed with an evaluation and
management service (list separately in addition to the code for
primary procedure)
AAPC Rationale
Report 90838 when 53 or more minutes of psychotherapy
are provided on the same date as an E/M service. The time
must be face-to-face with the patient and/or family. Do not
= Service/Procedure Includes Moderate Sedation

include time spent performing the E/M service as part of
the psychotherapy service. Select the appropriate E/M code
based on the documentation.
Psychiatry/Psychiatric Diagnostic Procedures:
Psychotherapy for Crises
New, time-based crisis codes have been established to
report treatment for urgent assessment and treatment for a
patient in a crisis state. The patients condition is typically
life threatening or complex.
90839 Psychotherapy for crisis; first 60 minutes
AAPC Rationale
Report 90839 for the first 60 minutes and 90840 (below)
for each additional 30 minutes. Time must be face-to-face
but is not required to be continuous.
90840 Psychotherapy for crisis; each additional 30 min-
utes (list separately in addition to code for primary service)
AAPC Rationale
Report 90839 (above) for the first 60 minutes and add-on
90840 for each additional 30 minutes. Time must be face-
to-face but is not required to be continuous.
90857 Interactive group psychotherapy
AAPC Rationale
Code 90857 has been deleted. Refer to 90785 with 90853.
90862 Pharmacologic management, including prescription,
use, and review of medication with no more than minimal medi-
cal psychotherapy
AAPC Rationale
Code 90862 has been deleted. A parenthetical note directs
you to 90863, or the appropriate E/M level if the providers
scope of practice allows reporting E/M service.
Psychiatry/Psychiatric Diagnostic Procedures:
Other Services or Procedures
90863 Pharmacologic management, including prescription
and review of medication, when performed with psychotherapy
services (list separately in addition to the code for primary pro-
cedure)
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
Code 90863 has been created to report pharmacologic
management when performed with psychotherapy services.
If the providers scope of practice allows for reporting E/M
codes, report the appropriate E/M instead of 90863.
A parenthetical note instructs you to report 90863 with
90832, 90834, or 90837.
p 90875 Individual psychophysiological therapy incorporat-
ing biofeedback training by any modality (face-to-face with the
patient), with psychotherapy (eg, insight oriented, behavior
modifying or supportive psychotherapy); approximately 20-30
minutes
AAPC Rationale
To be consistent with the other codes in the psychiatry cat-
egory, 90875 has been revised to specify 30 minutes.
p 90876 Individual psychophysiological therapy incorporat-
ing biofeedback training by any modality (face-to-face with the
patient), with psychotherapy (eg, insight oriented, behavior
modifying or supportive psychotherapy); approximately 45-50
minutes
AAPC Rationale
To be consistent with the other codes in the psychiatry cat-
egory, 90876 has been revised to specify 45 minutes.
p 90889 Preparation of report of patients psychiatric status,
history, treatment, or progress (other than for legal or consulta-
tive purposes) for other physicians individuals, agencies, or
insurance carriers
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90889 has been amended to allow that this
service may be provided by providers other than a physi-
cian, to report preparation of a patients psychiatric status,
history, treatment, or progress for other qualified individu-
als, physicians, agencies, or insurance carriers.
Complete 2013 Procedure Updates 33
Complete 2013 Procedure Coding Updates
Hemodialysis
p 90935 Hemodialysis procedure with single evaluation by a
physician evaluation or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90935 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Miscellaneous Dialysis Procedures
p 90945 Dialysis procedure other than hemodialysis (eg,
peritoneal dialysis, hemofiltration, or other continuous renal
replacement therapies), with single evaluation by a physician
evaluation or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90945 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90947 Dialysis procedure other than hemodialysis (eg,
peritoneal dialysis, hemofiltration, or other continuous renal
replacement therapies) requiring repeated evaluation by a
physician evaluation or other qualified health care professional,
with or without substantial revision of dialysis prescription
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90947 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
End-Stage Renal Disease Services
p 90951 End-stage renal disease (ESRD) related services
monthly, for patients younger than 2 years of age to include
monitoring for the adequacy of nutrition, assessment of growth
and development, and counseling of parents; with 4 or more
face-to-face visits by a physician visits or other qualified health
care professional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptors for 90951 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
34 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
p 90952 End-stage renal disease (ESRD) related services
monthly, for patients younger than 2 years of age to include
monitoring for the adequacy of nutrition, assessment of growth
and development, and counseling of parents; with 2-3 face-to-
face visits by a physician visits or other qualified health care
professional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90952 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90953 End-stage renal disease (ESRD) related services
monthly, for patients younger than 2 years of age to include
monitoring for the adequacy of nutrition, assessment of growth
and development, and counseling of parents; with 1 face-to-
face visits by a physician visits or other qualified health care
professional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90953 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90954 End-stage renal disease (ESRD) related services
monthly, for patients 2-11 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and develop-
ment, and counseling of parents; with 4 or more face-to-face
visits by a physician visits or other qualified health care profes-
sional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90954 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90955 end-stage renal disease (ESRD) related services
monthly, for patients 2-11 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and develop-
ment, and counseling of parents; with 2-3 face-to-face visits by
a physician visits or other qualified health care professional per
month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90955 has been amended to allow that this
= Service/Procedure Includes Moderate Sedation

service may be performed by a physician or other quali-
fied health care professional.
p 90956 End-stage renal disease (ESRD) related services
monthly, for patients 2-11 years of age to include monitoring for
the adequacy of nutrition, assessment of growth and develop-
ment, and counseling of parents; with 1 face-to-face visits by a
physician visits or other qualified health care professional per
month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90956 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90957 End-stage renal disease (ESRD) related services
monthly, for patients 12-19 years of age to include monitoring
for the adequacy of nutrition, assessment of growth and devel-
opment, and counseling of parents; with 4 or more face-to-face
visits by a physician visits or other qualified health care profes-
sional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90957 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90958 End-stage renal disease (ESRD) related services
monthly, for patients 12-19 years of age to include monitoring
for the adequacy of nutrition, assessment of growth and devel-
opment, and counseling of parents; with 2-3 face-to-face visits
by a physician visits or other qualified health care professional
per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90958 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90959 End-stage renal disease (ESRD) related services
monthly, for patients 12-19 years of age to include monitoring
for the adequacy of nutrition, assessment of growth and devel-
opment, and counseling of parents; with 1 face-to-face visits by
a physician visits or other qualified health care professional per
month
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90959 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90960 End-stage renal disease (ESRD) related services
monthly, for patients 20 years of age and older; with 4 or more
face-to-face visits by a physician visits or other qualified health
care professional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90960 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90961 End-stage renal disease (ESRD) related services
monthly, for patients 20 years of age and older; with 2-3 face-
to-face visits by a physician visits or other qualified health care
professional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90961 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 90962 End-stage renal disease (ESRD) related services
monthly, for patients 20 years of age and older; with 1 face-
to-face visits by a physician visits or other qualified health care
professional per month
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 90962 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Gastroenterology
p 91110 Gastrointestinal tract imaging, intraluminal (eg,
capsule endoscopy), esophagus through ileum, with physician
interpretation and report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 91110 has been amended to allow that this
service is not limited to physician reporting, and per AMA
Complete 2013 Procedure Updates 35
Complete 2013 Procedure Coding Updates
recommendation may be reported by other (non-physi-
cian), qualified attending health care professionals.
p 91111 Gastrointestinal tract imaging, intraluminal (eg, cap-
sule endoscopy), esophagus with physician interpretation and
report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 91111 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physi-
cian), qualified attending health care professionals.
91112 Gastrointestinal transit and pressure measurement,
stomach through colon, wireless capsule, with interpretation
and report
AAPC Rationale
Code 91112 replaces Category III code 0242T. The proce-
dure involves pressure measurements from the stomach to
the colon.
Special Ophthalmological Services: Other
p 92286 Special anterior Anterior segment photography imag-
ing with interpretation and report; with specular endothelial
microscopy and endothelial cell count analysis
AAPC Rationale
Because films have been replaced by digital images, the
code descriptor has been revised to more accurately report
the work done.
p 92287 Special anterior Anterior segment photography imag-
ing with interpretation and report; with fluorescein angiography
AAPC Rationale
Because films have been replaced by digital images, the
code descriptor has been revised to more accurately report
the work done.
Special Otorhinolaryngologic Services: percutaneous, with or without other therapeutic intervention,
Evaluative and Therapeutic Services
p 92613 Flexible fiberoptic endoscopic evaluation of swal-
lowing by cine or video recording; physician interpretation and
report only
36 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 92613 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 92615 Flexible fiberoptic endoscopic evaluation, laryngeal
sensory testing by cine or video recording; physician interpreta-
tion and report only
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 92615 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 92617 Flexible fiberoptic endoscopic evaluation of swallow-
ing and laryngeal sensory testing by cine or video recording;
physician interpretation and report only
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 92617 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
Cardiovascular: Coronary Therapeutic
Services and Procedures
92980 Transcatheter placement of an intracoronary stent(s),
percutaneous, with or without other therapeutic intervention,
any method; single vessel
AAPC Rationale
Codes 92980, 92981, 92982, and 92984 have been deleted.
See 9292092944.
92981 Transcatheter placement of an intracoronary stent(s),
any method; each additional vessel (List separately in addition
to code for primary procedure)
AAPC Rationale
Codes 92980, 92981, 92982, and 92984 have been deleted.
See 9292092944.
= Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure Coding Updates

92982 Percutaneous transluminal coronary balloon angio-
plasty; single vessel
AAPC Rationale
Codes 92980, 92981, 92982, and 92984 have been deleted.
See 9292092944.
92984 Percutaneous transluminal coronary balloon angio-
plasty; each additional vessel (List separately in addition to
code for primary procedure)
AAPC Rationale
Codes 92980, 92981, 92982, and 92984 have been deleted.
See 9292092944.
92995 Percutaneous transluminal coronary atherectomy, by
mechanical or other method, with or without balloon angio-
plasty; single vessel
AAPC Rationale
Codes 92995, 92996 have been deleted. See new codes
92924, 92925, and 9293392944.
92996 Percutaneous transluminal coronary atherectomy, by
mechanical or other method, with or without balloon angio-
plasty; each additional vessel (List separately in addition to
code for primary procedure)
AAPC Rationale
Codes 92995, 92996 have been deleted. See new codes
92924, 92925, and 9293392944.
Combination codes are used when the same vessel requires
angioplasty, stent, and atherectomy. You should report only
the most extensive procedure performed in each vessel.
During PCI, multiple procedures may be performed in
multiple vessels. You may report codes for the major coro-
nary arteries, as well as well as for branches of the coronary
arteries. The coronary arteries are left main, left anterior
descending, left circumflex, right main, and ramus inter-
medius. All segments (proximal, mid, distal) are included
in the major coronary artery procedure, unless one of the
segments requires access through a bypass graft, in which
case the bypass graft may be reported separately.
For coding purposes, the recognized branches of the major
coronary arteries are the diagonals of the left anterior
descending, marginals of left circumflex, and posterior
descending posterolaterals of the right. You may code no
more than two branches for a major coronary artery.
Base codes (92920, 92924, 92928, 92933, 92937, 92941,
and 92943) are reported for the most extensive procedure
in a major coronary artery. If PCI is performed during
the same session in additional major coronary arteries or
bypass graft, report the appropriate base code. If PCI is
performed in additional coronary branches, report the
applicable add-on code (92921, 92925, 92929, 92934,
92938, or 92944).
PCI includes access, selective catheterization, radiologic
supervision and interpretation, closure of arteriotomy, and
imaging to document completion of the procedure.

Cardiovascular/Therapeutic Services Diagnostic coronary angiography is usually included,

but may be separately reported under the circumstances
and Procedures: Coronary explained in the guidelines preceding the PCI codes.
Subsection Guidance
A new subsection has been added to CPT for coronary
therapeutic services and procedures, which includes
guidelines to define services and provide instruction for
code use.

To properly code percutaneous coronary interventions

(PCI), you must know the type of procedure(s) performed
(angioplasty, stent, and/or atherectomy). During angio-
plasty, a balloon-tipped catheter is inserted and inflated to
open an occluded vessel. Stent(s) may be required to prop
open the vessel. During atherectomy, a catheter with a
sharp blade is used to cut away the occlusion.

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 37

Complete 2013 Procedure Coding Updates
92920
Anatomical Illustrations 2012, OptumInsight, Inc.
# 92920 Percutaneous transluminal coronary angio-
plasty; single major coronary artery or branch
AAPC Rationale
Report angioplasty when no other invention (stent or
atherectomy) is performed in the major coronary artery.
Claim one unit of 92990 for each major coronary vessel.
# 92921 Percutaneous transluminal coronary angio-
plasty; each additional branch of a major coronary artery (list
separately in addition to code for primary procedure)
AAPC Rationale
Report 92921 for each additional branch of a major
artery. A parenthetical note describes which primary
codes 92921 may be reported with. Claim 92921 when
angioplasty is the only intervention performed in the
vessel.
38 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
# 92924 Percutaneous transluminal coronary atherec-
tomy, with coronary angioplasty when performed; single
major coronary artery or branch
AAPC Rationale
Report 92924 for atherectomy in a major coronary artery
or branch. Angioplasty performed in the same vessel is
included.
# 92925 Percutaneous transluminal coronary ather-
ectomy, with coronary angioplasty when performed; each
additional branch of a major coronary artery (list separately
in addition to code for primary procedure)
AAPC Rationale
Report 92925 for each additional branch of a major
coronary artery. A parenthetical note lists which primary
codes 92925 may be reported with. Angioplasty per-
formed in the same vessel is included.
# 92928 Percutaneous transcatheter placement of intra-
coronary stent(s), with coronary angioplasty when performed;
single major coronary artery or branch
AAPC Rationale
Report 92928 when one or more stents are placed in a
major coronary artery. The procedure is coded per major
coronary arterynot per stent placed. Angioplasty per-
formed in the same vessel is included.
# 92929 Percutaneous transcatheter placement of
intracoronary stent(s), with coronary angioplasty when per-
formed; each additional branch of a major coronary artery
(list separately in addition to code for primary procedure)
AAPC Rationale
Report 92929 when one or more stents are placed in an
additional branch of a major coronary artery. The proce-
dure is coded per major coronary artery branchnot per
stent placed. Angioplasty performed in the same vessel is
included.
= Service/Procedure Includes Moderate Sedation

# 92933 Percutaneous transluminal coronary atherec-
tomy, with intracoronary stent, with coronary angioplasty
when performed; single major coronary artery or branch
AAPC Rationale
Report combination code 92933 for angioplasty, stent(s),
and atherectomy performed in the same major coronary
artery or branch.
# 92934 Percutaneous transluminal coronary atherec-
tomy, with intracoronary stent, with coronary angioplasty when
performed; each additional branch of a major coronary artery
(list separately in addition to code for primary procedure)
AAPC Rationale
Report combination code 92934 for angioplasty, stent(s),
and atherectomy performed in each additional branch of
a major coronary artery.
# 92937 Percutaneous transluminal revascularization of
or through coronary artery bypass graft (internal mammary,
free arterial, venous), any combination of intracoronary stent,
atherectomy and angioplasty, including distal protection
when performed; single vessel
AAPC Rationale
New codes have been created to report any interven-
tion (angioplasty, stent, and/or atherectomy) performed
through a coronary bypass graft. When multiple inter-
ventions are performed on native vessels in addition to
bypass grafts, select a base code for the intervention for
the native vessels, as well as the bypass graft.
# 92938 Percutaneous transluminal revascularization of
or through coronary artery bypass graft (internal mammary,
free arterial, venous), any combination of intracoronary stent,
atherectomy and angioplasty, including distal protection
when performed; each additional branch subtended by the
bypass graft (list separately in addition to code for primary
procedure)
AAPC Rationale
Report add-on code 92938 for any intervention (angio-
plasty, stent, atherectomy) performed in each additional
branch subtended by the bypass graft.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
# 92941 Percutaneous transluminal revascularization of
acute total/subtotal occlusion during acute myocardial infarc-
tion, coronary artery or coronary artery bypass graft, any
combination of intracoronary stent, atherectomy and angio-
plasty, including aspiration thrombectomy when performed,
single vessel
AAPC Rationale
Report 92941 for any combination of services (angi-
ography, stent, atherectomy) for a patient having an
acute myocardial infarction causing an acute, subtotal
occlusion. Mechanical thrombectomy (92973) may be
reported separately, if performed.
# 92943 Percutaneous transluminal revascularization
of chronic total occlusion, coronary artery, coronary artery
branch, or coronary artery bypass graft, any combination
of intracoronary stent, atherectomy and angioplasty; single
vessel
AAPC Rationale
Report 92943 for any combination of services (angi-
ography, stent, atherectomy) for a patient with chronic
total occlusion. CPT defines chronic occlusion as no
antegrade flow through the true lumen, accompanied by
suggestive angiographic and clinical criteria. The clini-
cal criterion is included in the coding guidelines preced-
ing the PCI codes.
# 92944 Percutaneous transluminal revascularization
of chronic total occlusion, coronary artery, coronary artery
branch, or coronary artery bypass graft, any combination of
intracoronary stent, atherectomy and angioplasty; each addi-
tional coronary artery, coronary artery branch, or bypass graft
(list separately in addition to code for primary procedure)
AAPC Rationale
Report 92944 for each additional coronary artery,
branch, or bypass graft for any combination of services
(angiography, stent, atherectomy) for a patient with
chronic total occlusion. CPT defines chronic occlusion
as no antegrade flow through the true lumen, accom-
panied by suggestive angiographic and clinical criteria.
The clinical criterion is included in the coding guide-
lines preceding the PCI codes.
Complete 2013 Procedure Updates 39
Complete 2013 Procedure Coding Updates
# 92973 Percutaneous transluminal coronary throm-
bectomy mechanical (list separately in addition to code for
primary procedure)
AAPC Rationale
92973 was revised to add mechanical to promote
proper coding. This code is not reported for chemical
thrombectomy.
Cardiography
p 93015 Cardiovascular stress test using maximal or sub-
maximal treadmill or bicycle exercise, continuous electrocar-
diographic monitoring, and/or pharmacological stress; with
physician supervision, with interpretation and report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93015 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 93016 Cardiovascular stress test using maximal or sub-
maximal treadmill or bicycle exercise, continuous electrocardio-
graphic monitoring, and/or pharmacological stress; physician
supervision only, without interpretation and report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93016 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
Cardiovascular Monitoring Services
p 93224 External electrocardiographic recording up to 48
hours by continuous rhythm recording and storage; includes
recording, scanning analysis with report, physician review and
interpretation by a physician or other qualified health care pro-
fessional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93224 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
40 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
p 93227 External electrocardiographic recording up to 48
hours by continuous rhythm recording and storage; physician
review and interpretation by a physician or other qualified
health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93227 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93228 External mobile cardiovascular telemetry with elec-
trocardiographic recording, concurrent computerized real time
data analysis and greater than 24 hours of accessible ECG data
storage (retrievable with query) with ECG triggered and patient
selected events transmitted to a remote attended surveillance
center for up to 30 days; physician review and interpretation by
a physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93228 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93229 External mobile cardiovascular telemetry with elec-
trocardiographic recording, concurrent computerized real time
data analysis and greater than 24 hours of accessible ECG data
storage (retrievable with query) with ECG triggered and patient
selected events transmitted to a remote attended surveillance
center for up to 30 days; technical support for connection and
patient instructions for use, attended surveillance, analysis and
physician prescribed transmission of daily and emergent data
reports as prescribed by a physician or other qualified health
care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93229 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
= Service/Procedure Includes Moderate Sedation

p 93268 External patient and, when performed, auto acti-
vated electrocardiographic rhythm derived event recording with
symptom-related memory loop with remote download capability
up to 30 days, 24-hour attended monitoring; includes transmis-
sion, physician review and interpretation by a physician or other
qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93268 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93272 External patient and, when performed, auto acti-
vated electrocardiographic rhythm derived event recording with
symptom-related memory loop with remote download capability
up to 30 days, 24-hour attended monitoring; physician review
and interpretation by a physician or other qualified health care
professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93272 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Implantable and Wearable AAPC Rationale
Cardiac Device Evaluations
p 93279 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values with physician analysis, review and report by a physician
or other qualified health care professional; single lead pace-
maker system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93279 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93280 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values physician analysis, review and report by a physician or
other qualified health care professional; dual lead pacemaker
system
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93280 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93281 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values with physician analysis, review and report by a physician
or other qualified health care professional; multiple lead pace-
maker system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93281 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93282 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values with physician analysis, review and report by a physician
or other qualified health care professional; single lead implant-
able cardioverter-defibrillator system
Consistent with revisions throughout CPT 2013, the
descriptor for 93282 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93283 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values with physician analysis, review and report by a physician
or other qualified health care professional; dual lead implant-
able cardioverter-defibrillator system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93283 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Complete 2013 Procedure Updates 41
Complete 2013 Procedure Coding Updates
p 93284 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values with physician analysis, review and report by a physi-
cian or other qualified health care professional; multiple lead
implantable cardioverter-defibrillator system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93284 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93285 Programming device evaluation (in person) with
iterative adjustment of the implantable device to test the func-
tion of the device and select optimal permanent programmed
values with physician analysis, review and report by a physician
or other qualified health care professional; implantable loop
recorder system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93285 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93286 Peri-procedural device evaluation (in person) and
programming of device system parameters before or after a
surgery, procedure, or test with physician analysis, review and
report by a physician or other qualified health care professional;
single, dual, or multiple lead pacemaker system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93286 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93287 Peri-procedural device evaluation (in person) and
programming of device system parameters before or after a
surgery, procedure, or test with physician analysis, review and
report by a physician or other qualified health care profes-
sional; single, dual, or multiple lead implantable cardioverter-
defibrillator system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93287 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
42 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
p 93288 Interrogation device evaluation (in person) with
physician analysis, review and report by a physician or other
qualified health care professional, includes connection, record-
ing and disconnection per patient encounter; single, dual, or
multiple lead pacemaker system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93288 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93289 Interrogation device evaluation (in person) with phy-
sician analysis, review and report by a physician or other quali-
fied health care professional, includes connection, recording
and disconnection per patient encounter; single, dual, or mul-
tiple lead implantable cardioverter-defibrillator system, including
analysis of heart rhythm derived data elements
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93289 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93290 Interrogation device evaluation (in person) with
physician analysis, review and report by a physician or other
qualified health care professional, includes connection, record-
ing and disconnection per patient encounter; implantable
cardiovascular monitor system, including analysis of 1 or more
recorded physiologic cardiovascular data elements from all
internal and external sensors
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93290 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93291 Interrogation device evaluation (in person) with
physician analysis, review and report by a physician or other
qualified health care professional, includes connection, record-
ing and disconnection per patient encounter; implantable loop
recorder system, including heart rhythm derived data analysis
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93291 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
= Service/Procedure Includes Moderate Sedation

p 93292 Interrogation device evaluation (in person) with phy-
sician analysis, review and report by a physician or other quali-
fied health care professional, includes connection, recording
and disconnection per patient encounter; wearable defibrillator
system
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93292 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93293 Transtelephonic rhythm strip pacemaker
evaluation(s) single, dual, or multiple lead pacemaker system,
includes recording with and without magnet application with
physician analysis, review and report(s) by a physician or other
qualified health care professional, up to 90 days
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93293 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93294 Interrogation device evaluation(s) (remote), up to
90 days; single, dual, or multiple lead pacemaker system with
interim physician analysis, review and report(s) by a physician
or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93294 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93295 Interrogation device evaluation(s) (remote), up to
90 days; single, dual, or multiple lead implantable cardioverter-
defibrillator system with interim physician analysis, review and
report(s) by a physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93295 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
p 93297 Interrogation device evaluation(s), (remote) up to
30 days; implantable cardiovascular monitor system, includ-
ing analysis of 1 or more recorded physiologic cardiovascular
data elements from all internal and external sensors, physician
analysis, review and report(s) by a physician or other qualified
health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93297 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93298 Interrogation device evaluation(s), (remote) up to
30 days; implantable loop recorder system, including analysis
of recorded heart rhythm data, physician analysis, review and
report(s) by a physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93298 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Echocardiography
p 93351 Echocardiography, transthoracic, real-time with
image documentation (2d), includes M-mode recording, when
performed, during rest and cardiovascular stress test using
treadmill, bicycle exercise and/or pharmacologically induced
stress, with interpretation and report; including performance
of continuous electrocardiographic monitoring, with supervi-
sion by a physician supervision or other qualified health care
professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93351 has been amended to allow that the
supervision service may be performed by a physician or
other qualified health care professional.
Intracardiac Electrophysiological
Procedure/Studies
Subsection Guidance
To combine comprehensive electrophysiologic evaluation
with intracardiac catheter ablation of arrhythmogenic focus
services, codes 93651 and 93652 have been deleted and
replaced by new codes 9365393657.
Complete 2013 Procedure Updates 43
Complete 2013 Procedure Coding Updates

93651 Intracardiac catheter ablation of arrhythmogenic focus; 93655 Intracardiac catheter ablation of a discrete mech-
for treatment of supraventricular tachycardia by ablation of fast anism of arrhythmia which is distinct from the primary ablated
or slow atrioventricular pathways, accessory atrioventricular mechanism, including repeat diagnostic maneuvers, to treat a
connections or other atrial foci, singly or in combination spontaneous or induced arrhythmia (list separately in addition
to code for primary procedure)
AAPC Rationale
Codes 93651 and 93562 have been deleted. See new codes AAPC Rationale
9365393657. Report 93655 with 93653, 93654, or 93656 when an addi-
tional mechanism of arrhythmia requires ablation in addi-
tion to the primary site.
93652 Intracardiac catheter ablation of arrhythmogenic focus;
for treatment of ventricular tachycardia
93656 Comprehensive electrophysiologic evaluation includ-
AAPC Rationale
ing transseptal catheterizations, insertion and repositioning of
Codes 93651 and 93562 have been deleted. See new codes
multiple electrode catheters with induction or attempted induc-
9365393657.
tion of an arrhythmia with atrial recording and pacing, when
possible, right ventricular pacing and recording, his bundle
93653 Comprehensive electrophysiologic evaluation includ- recording with intracardiac catheter ablation of arrhythmogenic
ing insertion and repositioning of multiple electrode catheters focus, with treatment of atrial fibrillation by ablation by pulmo-
with induction or attempted induction of an arrhythmia with nary vein isolation
right atrial pacing and recording, right ventricular pacing and
AAPC Rationale
recording, HIS recording with intracardiac catheter ablation
Report 93656 when comprehensive electrophysiologic
of arrhythmogenic focus; with treatment of supraventricular
evaluation is performed in addition to ablation of atrial
tachycardia by ablation of fast or slow atrioventricular pathway,
fibrillation. Atrial fibrillation is an abnormal heart rhythm
accessory atrioventricular connection, cavo-tricuspid isthmus or
where the upper chambers of the heart (atria) beat irregu-
other single atrial focus or source of atrial re-entry
larly and rapidly.
AAPC Rationale
Report 93653 when comprehensive electrophysiologic
93657 Additional linear or focal intracardiac catheter
evaluation is performed in addition to ablation of supra-
ablation of the left or right atrium for treatment of atrial fibrilla-
ventricular tachycardia. Ablation is the destruction of
tion remaining after completion of pulmonary vein isolation (list
tissue in the heart to correct arrhythmia. Supraventricular
separately in addition to code for primary procedure)
tachycardia (SVT) is rapid heart rhythm originating above
the ventricular tissue. AAPC Rationale
Report 93657 with 93657 if ablation of the left or right
atrium is required for atrial fibrillation remaining after
93654 Comprehensive electrophysiologic evaluation includ-
pulmonary vein isolation.
ing insertion and repositioning of multiple electrode catheters
with induction or attempted induction of an arrhythmia with
right atrial pacing and recording, right ventricular pacing and Noninvasive Physiologic Studies and Procedures
recording, HIS recording with intracardiac catheter ablation of
p 93745 Initial set-up and programming by a physician or
arrhythmogenic focus; with treatment of ventricular tachycardia
other qualified health care professional of wearable cardio-
or focus of ventricular ectopy including intracardiac electro-
verter-defibrillator includes initial programming of system,
physiologic 3d mapping, when performed, and left ventricular
establishing baseline electronic ECG, transmission of data
pacing and recording, when performed
to data repository, patient instruction in wearing system and
AAPC Rationale patient reporting of problems or events
Report 93654 when comprehensive electrophysiologic
AAPC Rationale
evaluation is performed in addition to ablation of ventricu-
Consistent with revisions throughout CPT 2013, the
lar tachycardia or focus of ventricular ectopy. Ablation is
descriptor for 93745 has been amended to allow that this
the destruction of tissue in the heart to correct arrhythmia.
service may be performed by a physician or other quali-
Ventricular tachycardia is rapid heartbeat that starts in the
fied health care professional.
ventricles.

44 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

p 93750 Interrogation of ventricular assist device (VAD), in
person, with physician or other qualified health care profes-
sional analysis of device parameters (eg, drivelines, alarms,
power surges), review of device function (eg, flow and volume
status, septum status, recovery), with programming, if per-
formed, and report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93750 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93790 Ambulatory blood pressure monitoring, utilizing a
system such as magnetic tape and/or computer disk, for 24
hours or longer; physician review with interpretation and report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93790 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
Cardiovascular: Other Procedures
p 93797 Physician or other qualified health care professional
services for outpatient cardiac rehabilitation; without continuous
ECG monitoring (per session)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93797 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 93798 Physician or other qualified health care professional
services for outpatient cardiac rehabilitation; with continuous
ECG monitoring (per session)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 93798 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
Pulmonary: Diagnostic Testing and Therapies
p 94014 Patient-initiated spirometric recording per 30-day
period of time; includes reinforced education, transmission of
spirometric tracing, data capture, analysis of transmitted data,
periodic recalibration and physician review and interpretation by
a physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94014 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 94016 Patient-initiated spirometric recording per 30-day
period of time; physician review and interpretation by a physi-
cian or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94016 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 94452 High altitude simulation test (HAST), with physi-
cian interpretation and report by a physician or other qualified
health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94452 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 94453 High altitude simulation test (hast), with physician
interpretation and report by a physician or other qualified
health care professional; with supplemental oxygen titration
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94453 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Complete 2013 Procedure Updates 45
Complete 2013 Procedure Coding Updates
p 94610 Intrapulmonary surfactant administration by a physi-
cian or other qualified health care professional through endotra-
cheal tube
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94610 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Code 94610 is Modifier 51 exempt.
p 94774 Pediatric home apnea monitoring event recording
including respiratory rate, pattern and heart rate per 30-day
period of time; includes monitor attachment, download of data,
physician review, interpretation, and preparation of a report by
a physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94774 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 94777 Pediatric home apnea monitoring event recording
including respiratory rate, pattern and heart rate per 30-day
period of time; physician review, interpretation, and prepara-
tion of a report by a physician or other qualified health care
professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 94777 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Allergy and Clinical Immunology: Allergy Testing
p 95004 Percutaneous tests (scratch, puncture, prick) with
allergenic extracts, immediate type reaction, including test inter-
pretation and report by a physician, specify number of tests
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95004 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
46 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
95010 Percutaneous tests (scratch, puncture, prick) sequential
and incremental, with drugs, biologicals or venoms, immediate
type reaction, including test interpretation and report by a phy-
sician, specify number of tests
AAPC Rationale
Codes 95010 and 95015 have been deleted and replaced by
95017 and 95018.
95015 Intracutaneous (intradermal) tests, sequential and
incremental, with drugs, biologicals, or venoms, immediate type
reaction, including test interpretation and report by a physician,
specify number of tests
AAPC Rationale
Codes 95010 and 95015 have been deleted and replaced by
95017 and 95018.
95017 Allergy testing, any combination of percutaneous
(scratch, puncture, prick) and intracutaneous (intradermal),
sequential and incremental, with venoms, immediate type
reaction, including test interpretation and report, specify
number of tests
AAPC Rationale
Codes 95010 and 95015 have been deleted. New codes
describe percutaneous and/or intracutaneous allergy test-
ing. The codes are selected based on whether the testing is
with venoms or drugs and biological.
Report 95017 for allergy testing with venoms.
95018 Allergy testing, any combination of percutaneous
(scratch, puncture, prick) and intracutaneous (intradermal),
sequential and incremental, with drugs or biologicals, imme-
diate type reaction, including test interpretation and report,
specify number of tests
AAPC Rationale
Codes 95010 and 95015 have been deleted. New codes
describe percutaneous and/or intracutaneous allergy test-
ing. The codes are selected based on whether the testing is
with venoms or drugs and biological.
Report 95017 when performing allergy testing with drugs
or biologicals.
= Service/Procedure Includes Moderate Sedation

p 95024 Intracutaneous (intradermal) tests with allergenic
extracts, immediate type reaction, including test interpretation
and report by a physician, specify number of tests
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95024 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95027 Intracutaneous (intradermal) tests, sequential and
incremental, with allergenic extracts for airborne allergens,
immediate type reaction, including test interpretation and
report by a physician, specify number of tests
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95027 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
Allergy and Clinical Immunology: Ingesting
Challenge Testing
95075 Ingestion challenge test (sequential and incremental
ingestion of test items, eg, food, drug or other substance such
as metabisulfite)
AAPC Rationale
Code 95075 has been deleted and replaced with time-
based codes 95076 and 95079.
95076 Ingestion challenge test (sequential and incremental
ingestion of test items, eg, food, drug or other substance); ini-
tial 120 minutes of testing
AAPC Rationale
Report 95076 for the first 120 minutes of testing to con-
firm an allergy by ingestion challenge test. Time-based
codes 95076 and 95079 replace deleted code 95075.
95079 Ingestion challenge test (sequential and incremen-
tal ingestion of test items, eg, food, drug or other substance);
each additional 60 minutes of testing (list separately in addition
to code for primary procedure)
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
AAPC Rationale
Report add-on code 95079 for each additional 60 min-
utes, beyond the initial 120 minutes of testing (95076), to
confirm an allergy by ingestion challenge test. Time-based
codes 95076 and 95079 replace deleted code 95075.
Allergy and Clinical Immunology: Allergen
Immunotherapy
p 95120 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; single injection
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95120 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95125 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; 2 or more injections
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95125 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95130 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; single stinging insect venom
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95130 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95131 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; 2 stinging insect venoms
Complete 2013 Procedure Updates 47
Complete 2013 Procedure Coding Updates
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95131 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95132 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; 3 stinging insect venoms
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95132 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95133 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; 4 stinging insect venoms
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95133 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
p 95134 Professional services for allergen immunotherapy in
prescribing physicians the office or institution of the prescribing
physician or other qualified health care professional, including
provision of allergenic extract; 5 stinging insect venoms
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95134 has been amended to allow that this
service is not limited to physician reporting, and per AMA
recommendation may be reported by other (non-physician),
qualified attending health care professionals.
48 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
Neurology and Neuromuscular Procedures:
Sleep Medicine Testing
p 95808 Polysomnography; any age, sleep staging with 1-3
additional parameters of sleep, attended by a technologist
AAPC Rationale
New polysomnography codes specify patient age, as well as
type of study performed: 95808 has been revised to indi-
cate the code may be reported for any age.
p 95810 Polysomnography; age 6 years or older, sleep stag-
ing with 4 or more additional parameters of sleep, attended by
a technologist
AAPC Rationale
New polysomnography codes specify patient age, as well as
type of study performed: 95810 has been revised to indi-
cate the code can be reported for patients six years of age,
or older.
p 95811 Polysomnography; age 6 years or older, sleep stag-
ing with 4 or more additional parameters of sleep, with initia-
tion of continuous positive airway pressure therapy or bilevel
ventilation, attended by a technologist
AAPC Rationale
New polysomnography codes specify patient age, as well as
type of study performed: 95811 was revised to indicate the
code may be reported for patients six years old, or older.
This code differs from 95810 in that it includes initiation
of continuous positive airway pressure (CPAP) therapy or
bilevel ventilation. CPAP is performed by a machine that
uses mild air pressure to keep the airways open. If obstruc-
tive sleep apnea is identified during a polysomnography,
CPAP titration is performed to determine the pressure
needed to resolve the sleep apnea, and to determine the
appropriate settings if the patient needs a positive airway
pressure device for treatment.
= Service/Procedure Includes Moderate Sedation

# 95782 Polysomnography; younger than 6 years, sleep
staging with 4 or more additional parameters of sleep,
attended by a technologist
AAPC Rationale
Code 95782 describes polysomnography in patients
younger than 6 years of age. The study includes sleep
staging and four or more additional sleep parameters.
The additional parameters are defined in the coding
guidelines preceding the polysomnography codes.
If fewer than seven hours of reporting are performed,
append modifier 52.
# 95783 Polysomnography; younger than 6 years, sleep
staging with 4 or more additional parameters of sleep, with
initiation of continuous positive airway pressure therapy or
bi-level ventilation, attended by a technologist
AAPC Rationale
Code 95783 describes polysomnography in patients
younger than 6 years of age. The study includes sleep
staging and four or more additional sleep parameters.
The additional parameters are defined in the coding
guidelines preceding the polysomnography codes.
This study also includes the initiation of continuous
positive airway pressure (CPAP) or bi-level ventilation.
CPAP is performed by a machine that uses mild air pres-
sure to keep the airways open. If obstructive sleep apnea
is identified during a polysomnography, CPAP titra-
tion is performed to determine the pressure needed to
resolve the sleep apnea, and to determine the appropriate
settings if the patient needs a positive airway pressure
device for treatment.
If fewer than seven hours of reporting are performed,
append modifier 52.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
Neurology and Neuromuscular Procedures:
Routine Electroencephalography
p 95830 Insertion by physician or other qualified health care
professional of sphenoidal electrodes for electroencephalo-
graphic (EEG) recording
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95830 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Neurology and Neuromuscular Procedures:
Nerve Conduction Tests
Subsection Guidance
New coding guidelines define services performed for
motor and nerve conduction studies. Motor nerve conduc-
tion studies require electrodes to be placed over the motor
points of the muscle being tested. Nerve conduction stud-
ies require electrodes to be placed over the specific nerve to
be tested.
Codes are selected based on the number of studies per-
formed. A study is defined as sensory conduction test, a
motor conduction test with or without an F-wave test, or
an H-reflex test.
Nerve conduction studies are reported only once when the
test includes multiple sites on the same nerve. To assist
with coding, Appendix J includes a list of nerves and a
table indicating the reasonable maximum number of stud-
ies performed for common diagnosis.
When electromyography is performed with nerve conduc-
tion studies, use 9588595887.
95900 Nerve conduction, amplitude and latency/velocity study,
each nerve; motor, without F-wave study
AAPC Rationale
Codes 9500095004 have been deleted. See new codes
9590795913.
95903 Nerve conduction, amplitude and latency/velocity study,
each nerve; motor, with F-wave study
AAPC Rationale
Codes 9500095004 have been deleted. See new codes
9590795913.
Complete 2013 Procedure Updates 49
Complete 2013 Procedure Coding Updates
95904 Nerve conduction, amplitude and latency/velocity study,
each nerve; sensory
AAPC Rationale
Codes 9500095004 have been deleted. See new codes
9590795913.
95907 Nerve conduction studies; 1-2 studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95907 for one or two studies.
95908 Nerve conduction studies; 3-4 studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95908 for three to four studies.
95909 Nerve conduction studies; 5-6 studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95909 for five to six studies.
95910 Nerve conduction studies; 7-8 studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95910 for seven to eight studies.
95911 Nerve conduction studies; 9-10 studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95911 for nine to 10 studies.
95912 Nerve conduction studies; 11-12 studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95912 for 11 to 12 studies.
95913 Nerve conduction studies; 13 or more studies
AAPC Rationale
Report nerve conduction studies based on the number of
studies performed: Claim 95913 for 13 or more studies.
50 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
Neurology and Neuromuscular Procedures:
Autonomic Function Tests
95920 Intraoperative neurophysiology testing, per hour (List
separately in addition to code for primary procedure)
AAPC Rationale
Code 95920 has been deleted. For intraoperative neuro-
physiology monitoring, see new add-on codes 95940 and
95941.
Subsection Guidance
Continuous intraoperative neurophysiology monitoring
can be performed either in or outside of the operating
room. These add-on codes are reported for monitoring
time, in addition to the codes for the baseline studies
(a parenthetical note lists the appropriate baseline study
codes).
Intraoperative monitoring performed by the surgeon or
anesthesiologist is not reported separately.
# 95940 Continuous intraoperative neurophysiology
monitoring in the operating room, one on one monitoring
requiring personal attendance, each 15 minutes (list sepa-
rately in addition to code for primary procedure)
AAPC Rationale
Report 95940 for intraoperative neurophysiology moni-
toring, for each 15 minutes of monitoring time per-
formed in the operating room. Do not count the time
performing baseline tests in the time for monitoring. No
other cases can be monitored when reporting 95940.
# 95941 Continuous intraoperative neurophysiology
monitoring, from outside the operating room (remote or
nearby) or for monitoring of more than one case while in the
operating room, per hour (list separately in addition to code
for primary procedure)
AAPC Rationale
Report 95941 for intraoperative neurophysiology moni-
toring, per hour, for monitoring outside of the operat-
ing room, or when monitoring more than one case in
the operating room. Do not count the time performing
baseline tests in the time for monitoring. Do not report
if monitoring lasts 30 minutes or less.
= Service/Procedure Includes Moderate Sedation

# 95924 Testing of autonomic nervous system function;
combined parasympathetic and sympathetic adrenergic func-
tion testing with at least 5 minutes of passive tilt
AAPC Rationale
Code 95924 describes combined parasympathetic and
sympathetic adrenergic function tests. The tests are per-
formed to determine the presence and site of autonomic
dysfunction, and the autonomic subsystems that may
be disordered. Report 95924 if the service described by
95921 and 95922 are performed during the same session.
# 95943 Simultaneous, independent, quantitative mea-
sures of both parasympathetic function and sympathetic
function, based on time-frequency analysis of heart rate vari-
ability concurrent with time-frequency analysis of continuous
respiratory activity, with mean heart rate and blood pressure
measures, during rest, paced (deep) breathing, Valsalva
maneuvers, and head-up postural change
AAPC Rationale
Report 95943 if a tilt table is not used during autonomic
function tests: 9592195924 require the use of a tilt table.
95934 H-reflex, amplitude and latency study; record gastrocne-
mius/soleus muscle
AAPC Rationale
Codes 95934, 95936 have been deleted. Refer to 95907
95913.
95936 H-reflex, amplitude and latency study; record muscle
other than gastrocnemius/soleus muscle
AAPC Rationale
Codes 95934, 95936 have been deleted. Refer to 95907
95913.
Neurology and Neuromuscular Procedures:
Special EEG Tests
p 95954 Pharmacological or physical activation requiring
physician or other qualified health care professional attendance
during EEG recording of activation phase (eg, thiopental activa-
tion test)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95954 has been amended to allow that this
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
service may be performed by a physician or other quali-
fied health care professional.
p 95961 Functional cortical and subcortical mapping by
stimulation and/or recording of electrodes on brain surface, or
of depth electrodes, to provoke seizures or identify vital brain
structures; initial hour of attendance by a physician attendance
or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95961 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 95962 Functional cortical and subcortical mapping by
stimulation and/or recording of electrodes on brain surface, or
of depth electrodes, to provoke seizures or identify vital brain
structures; each additional hour of attendance by a physician
attendance or other qualified health care professional (list sepa-
rately in addition to code for primary procedure)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95962 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Neurology and Neuromuscular Procedures:
Other
p 95991 Refilling and maintenance of implantable pump or
reservoir for drug delivery, spinal (intrathecal, epidural) or brain
(intraventricular), includes electronic analysis of pump, when
performed; requiring skill of a physicians skill or other qualified
health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 95991 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Neurology and Neuromuscular Procedures:
Motion Analysis
p 96004 Physician review Review and interpretation by physi-
cian or other qualified health care professional of comprehen-
sive computer-based motion analysis, dynamic plantar pressure
Complete 2013 Procedure Updates 51
Complete 2013 Procedure Coding Updates
measurements, dynamic surface electromyography during walk-
ing or other functional activities, and dynamic fine wire electro-
myography, with written report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 96004 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Neurology and Neuromuscular Procedures:
Functional Brain Mapping
p 96020 Neurofunctional testing selection and administration
during noninvasive imaging functional brain mapping, with test
administered entirely by a physician or other qualified health
care professional (ie, psychologist), with review of test results
and report
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 96020 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Physical Medicine and Rehabilitation: direct one-on-one contact by provider, each 15 minutes
Therapeutic Procedures
p 97530 Therapeutic activities, direct (one-on-one) patient
contact by the provider (use of dynamic activities to improve
functional performance), each 15 minutes
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 97530 has been amended to allow greater
flexibility in who may report this service.
p 97532 Development of cognitive skills to improve attention,
memory, problem solving (includes compensatory training),
direct (one-on-one) patient contact by the provider, each 15
minutes
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 97532 has been amended to allow greater
flexibility in who may report this service.
52 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
p 97533 Sensory integrative techniques to enhance sensory
processing and promote adaptive responses to environmental
demands, direct (one-on-one) patient contact, by the provider
each 15 minutes
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 97533 has been amended to allow greater
flexibility in who may report this service.
p 97535 Self-care/home management training (eg, activities
of daily living (ADL) and compensatory training, meal prepara-
tion, safety procedures, and instructions in use of assistive
technology devices/adaptive equipment) direct one-on-one con-
tact, by the provider each 15 minutes
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 97535 has been amended to allow greater
flexibility in who may report this service.
p 97537 Community/work reintegration training (eg, shop-
ping, transportation, money management, avocational activities
and/or work environment/modification analysis, work task anal-
ysis, use of assistive technology device/adaptive equipment),
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 97537 has been amended to allow greater
flexibility in who may report this service.
Physical Medicine and Rehabilitation:
Tests and Measurements
p 97755 Assistive technology assessment (eg, to restore,
augment or compensate for existing function, optimize func-
tional tasks and/or maximize environmental accessibility), direct
one-on-one contact by provider, with written report, each 15
minutes
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 97755 has been amended to allow greater
flexibility in who may report this service.
= Service/Procedure Includes Moderate Sedation

Non-Face-to-Face Nonphysician Services: p 99070 Supplies and materials (except spectacles), provided
On-line Medical Evaluation
p 98969 Online assessment and management service pro-
vided by a qualified nonphysician health care professional to
an established patient, or guardian, or health care provider, not
originating from a related assessment and management service
provided within the previous 7 days, using the internet or simi-
lar electronic communications network
AAPC Rationale
This code was revised to remove "other qualified health
care professional" because a health care provider would
not provide an assessment on another health care provider.
The code was revised to correct an error made in the code
description.
Special Services, Procedures and Reports:
Miscellaneous
p 99000 Handling and/or conveyance of specimen for trans-
fer from the physicians office to a laboratory
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99000 has been amended to allow greater
flexibility in who may report this service.
p 99001 Handling and/or conveyance of specimen for trans-
fer from the patient in other than a physicians an office to a
laboratory (distance may be indicated)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99001 has been amended to allow greater
flexibility in who may report this service.
p 99002 Handling, conveyance, and/or any other service in
connection with the implementation of an order involving devices
(eg, designing, fitting, packaging, handling, delivery or mailing)
when devices such as orthotics, protectives, prosthetics are
fabricated by an outside laboratory or shop but which items have
been designed, and are to be fitted and adjusted by the attend-
ing physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99002 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
by the physician or other qualified health care professional over
and above those usually included with the office visit or other
services rendered (list drugs, trays, supplies, or materials pro-
vided)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99070 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 99071 Educational supplies, such as books, tapes, and pam-
phlets, provided by the physician for the patients education at
cost to physician or other qualified health care professional
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99071 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 99078 Physician or other qualified health care professional
qualified by education, training, licensure/regulation (when
applicable) educational services rendered to patients in a group
setting (eg, prenatal, obesity, or diabetic instructions)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99078 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional qualified by education, train-
ing, licensure/regulation.
p 99091 Collection and interpretation of physiologic data (eg,
ECG, blood pressure, glucose monitoring) digitally stored and/
or transmitted by the patient and/or caregiver to the physician
or other qualified health care professional, qualified by educa-
tion, training, licensure/regulation (when applicable) requiring a
minimum of 30 minutes of time
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99091 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional qualified by education, train-
ing, licensure/regulation.
Complete 2013 Procedure Updates 53
Complete 2013 Procedure Coding Updates
Moderate (Conscious) Sedation
p 99143 Moderate sedation services (other than those ser-
vices described by codes 00100-01999) provided by the same
physician or other qualified health care professional perform-
ing the diagnostic or therapeutic service that the sedation
supports, requiring the presence of an independent trained
observer to assist in the monitoring of the patients level of con-
sciousness and physiological status; younger than 5 years of
age, first 30 minutes intra-service time
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99143 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Code 99143 is modifier 51 exempt.
p 99144 Moderate sedation services (other than those ser-
vices described by codes 00100-01999) provided by the same
physician or other qualified health care professional perform-
ing the diagnostic or therapeutic service that the sedation
supports, requiring the presence of an independent trained
observer to assist in the monitoring of the patients level of con-
sciousness and physiological status; age 5 years or older, first
30 minutes intra-service time
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99144 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Code 99144 is modifier 51 exempt.
p 99145 Moderate sedation services (other than those
services described by codes 00100-01999) provided by the
same physician or other qualified health care professional per-
forming the diagnostic or therapeutic service that the sedation
supports, requiring the presence of an independent trained
observer to assist in the monitoring of the patients level of
consciousness and physiological status; each additional 15
minutes intra-service time (list separately in addition to code for
primary service)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99145 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
54 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
p 99148 Moderate sedation services (other than those ser-
vices described by codes 00100-01999), provided by a physi-
cian or other qualified health care professional other than the
health care professional performing the diagnostic or therapeu-
tic service that the sedation supports; younger than 5 years of
age, first 30 minutes intra-service time
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99148 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 99149 Moderate sedation services (other than those ser-
vices described by codes 00100-01999), provided by a physi-
cian or other qualified health care professional other than the
health care professional performing the diagnostic or therapeu-
tic service that the sedation supports; age 5 years or older, first
30 minutes intra-service time
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99149 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
p 99150 Moderate sedation services (other than those
services described by codes 00100-01999), provided by a
physician or other qualified health care professional other than
the health care professional performing the diagnostic or thera-
peutic service that the sedation supports; each additional 15
minutes intra-service time (list separately in addition to code for
primary service)
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99150 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Medicine: Other Services and Procedures
p 99174 Ocular photoscreening with interpretation and report
Instrument-based ocular screening (eg, photoscreening, auto-
mated-refraction), bilateral
AAPC Rationale
Code 99174 has been revised to more accurately describe
the procedure performed. Photoscreening and automated
refraction instruments are used when performing this
screening test.
= Service/Procedure Includes Moderate Sedation

p 99183 Physician or other qualified health care professional
attendance and supervision of hyperbaric oxygen therapy, per
session
AAPC Rationale
Consistent with revisions throughout CPT 2013, the
descriptor for 99183 has been amended to allow that this
service may be performed by a physician or other quali-
fied health care professional.
Category II Codes
Category II codes are supplemental tracking codes to
report performance measures, which are specific services
and test results that have been shown through evidence-
based medicine to support and contribute to quality
patient care.
Reporting of Category II codes is optional, at this time.
Category II codes have no relative value associated with
them because they describe clinical components included
in E/M or other clinical services. Category II codes should
not be used in place of Category I or Category III codes.
For 2013, CPT has added seven new Category II codes,
revised six codes, and deleted one code. For additional
information on these codes, consult your CPT codebook
or the AMA website at: www.ama-assn.org/ama/pub/
physician-resources/solutions-managing-your-practice/
coding-billing-insurance/cpt/about-cpt/category-ii-
codes.page?.
Category III Codes
Category III codes describe emerging technologies and,
unlike Category I unlisted procedure codes, allow for
tracking and collection of specific data. If a Category III
code is available, it must be reported instead of a Category
I unlisted procedure code. Category III codes have a five-
year life span: Per CPT guidelines, if a Category III code
is not replaced by a Category I code (or otherwise revised)
within five years, the Category III code will sunset (i.e.,
be archived), unless it is demonstrated that a temporary
code is still needed.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
Category III Code
0030T Antiprothrombin (phospholipid cofactor) antibody, each
Ig class
AAPC Rationale
Code 0030T has been deleted. Use 86849 for antipro-
thrombin antibody.
0048T Implantation of a ventricular assist device, extracorporeal,
percutaneous transseptal access, single or dual cannulation
AAPC Rationale
Code 00487 has been deleted. Refer to new code 33991.
0050T Removal of a ventricular assist device, extracorporeal,
percutaneous transseptal access, single or dual cannulation
AAPC Rationale
Code 0050T has been deleted. Refer to new codes 33990-
33993.
0173T Monitoring of intraocular pressure during vitrectomy sur-
gery (List separately in addition to code for primary procedure)
AAPC Rationale
Code 0173T has been deleted.
p 0195T Arthrodesis, pre-sacral interbody technique, disc
space preparation, discectomy, including without instrumenta-
tion, imaging (when performed) with image guidance, and
discectomy to prepare interspace, lumbar includes bone graft
when performed; single L5-S1 interspace
AAPC Rationale
Code 0195T was revised to include bundled services and to
indicate the procedure is performed without instrumenta-
tion, to distinguish it from 22586.
p 0196T Arthrodesis, pre-sacral interbody technique, disc
space preparation, discectomy, including without instrumenta-
tion, imaging (when performed) with image guidance, and
discectomy to prepare interspace, lumbar includes bone graft
when performed; each additional L4-L5 interspace (list sepa-
rately in addition to code for primary procedure)
AAPC Rationale
Code 0196T was revised to include bundled services and to
indicate the procedure is performed without instrumenta-
tion, to distinguish it from 22586.
Complete 2013 Procedure Updates 55
Complete 2013 Procedure Coding Updates

p 0206T Algorithmic Computerized database analysis of 0257T Implantation of catheter-delivered prosthetic aortic heart
multiple cycles of digitized cardiac electrical data from two or valve; open thoracic approach (eg, transapical, transventricular)
more ECG leads, including transmission to a remote center,
AAPC Rationale
application of electrocardiographic-derived data multiple non-
Code 0257T has been deleted. Refer to new codes 33365
linear mathematical transformations, with computer probability
and 0318T.
assessment, including report coronary artery obstruction sever-
ity assessment
0258T Transthoracic cardiac exposure (eg, sternotomy, thora-
AAPC Rationale
cotomy, subxiphoid) for catheter-delivered aortic valve replace-
Code 0206T has been revised to more accurately describe
ment; without cardiopulmonary bypass
the procedure. This code is used to identify coronary artery
obstruction, and is not intended for cardiac ischemia. AAPC Rationale
Code 0258T has been deleted. Refer to new codes 33365
and 33366.
0242T Gastrointestinal tract transit and pressure measure-
ment, stomach through colon, wireless capsule, with interpreta-
tion and report 0259T Transthoracic cardiac exposure (eg, sternotomy, thora-
cotomy, subxiphoid) for catheter-delivered aortic valve replace-
AAPC Rationale
ment; with cardiopulmonary bypass
Code 0242T has been deleted. Refer to new code 91112.
AAPC Rationale
Code 0259T has been deleted. Refer to new codes 33365
0250T Airway sizing and insertion of bronchial valve(s), each
33369.
lobe (List separately in addition to code for primary procedure)
AAPC Rationale
0276T Bronchoscopy, rigid or flexible, including fluoroscopic
Code 0250T has been deleted. Refer to new codes 31647-
guidance, when performed; with bronchial thermoplasty, 1 lobe
31649.
AAPC Rationale
Codes 0276T and 0277T have been deleted. Refer to new
0251T Bronchoscopy, rigid or flexible, including fluoroscopic
codes 31660 and 31661.
guidance, when performed; with removal of bronchial valve(s),
initial lobe
0277T Bronchoscopy, rigid or flexible, including fluoroscopic
AAPC Rationale
guidance, when performed; with bronchial thermoplasty, 2 or
Code 0251T has been deleted. Refer to new codes 31647
more lobes
31649.
AAPC Rationale
Codes 0276T and 0277T have been deleted. Refer to new
0252T Bronchoscopy, rigid or flexible, including fluoroscopic
codes 31660 and 31661.
guidance, when performed; with removal of bronchial valve(s),
each additional lobe (List separately in addition to code for pri-
mary procedure) 0279T Cell enumeration using immunologic selection and iden-
tification in fluid specimen (eg, circulating tumor cells in blood)
AAPC Rationale
Code 0252T has been deleted. Refer to new codes 31647 AAPC Rationale
31649. Codes 0279T and 0280T have been deleted. Refer to new
codes 86152 and 86153.
0256T Implantation of catheter-delivered prosthetic aortic
heart valve; endovascular approach
AAPC Rationale
Code 0256T has been deleted. Refer to new codes 33361
33364.

56 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation

0280T Cell enumeration using immunologic selection and iden-
tification in fluid specimen (eg, circulating tumor cells in blood);
interpretation and report
AAPC Rationale
Codes 0279T and 0280T have been deleted. Refer to new
codes 86152 and 86153.
0291T intravascular optical coherence tomography (coro-
nary native vessel or graft) during diagnostic evaluation and/
or therapeutic intervention, including imaging supervision, inter-
pretation, and report; initial vessel (list separately in addition to
primary procedure)
AAPC Rationale
Intravascular optical coherence tomography provides
microstructural information on atherosclerotic plaques.
Report 0291T in addition to cardiac catheterization
(92920, 92924, 92928, 92933, 92937, 92941, 92943,
92975, 9345493461, 93563, 93564) for the initial vessel.
0292T Intravascular optical coherence tomography
(coronary native vessel or graft) during diagnostic evaluation
and/or therapeutic intervention, including imaging supervision,
interpretation, and report; each additional vessel (list separately
in addition to primary procedure)
AAPC Rationale
Intravascular optical coherence tomography provides
microstructural information on atherosclerotic plaques.
Report 0292 for each additional vessel, as an add-on with
0291T and primary cardiac catheterization (92920, 92924,
92928, 92933, 92937, 92941, 92943, 92975, 93454-93461,
93563, 93564).
0293T Insertion of left atrial hemodynamic monitor;
complete system, includes implanted communication module
and pressure sensor lead in left atrium including transseptal
access, radiological supervision and interpretation, and associ-
ated injection procedures, when performed
AAPC Rationale
Code 0293T describes insertion of a device to monitor left
atrial pressure, to identify pressure changes in patients with
heart failure. Do not report 0293T with 93462 or 93662.
0294T Insertion of left atrial hemodynamic monitor;
pressure sensor lead at time of insertion of pacing cardioverter-
defibrillator pulse generator including radiological supervision
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
and interpretation and associated injection procedures, when
performed (list separately in addition to code for primary pro-
cedure)
AAPC Rationale
Report 0294T for insertion of a device to monitor left
atrial pressure, when performed during insertion of a
pacing cardioverter-defibrillator. The device is used to
identify pressure changes in patients with heart failure.
Claim 0294T in addition to 33230, 33231, 33240, 33262
33264, or 33249. Do not report with 93462 or 93662.
0295T External electrocardiographic recording for more
than 48 hours up to 21 days by continuous rhythm recording
and storage; includes recording, scanning analysis with report,
review and interpretation
AAPC Rationale
New codes describe external electrocardiographic record-
ing for more than 48 hours, up to 21 days. Current codes
(9322492337) report similar recording when performed
up to 48 hours.
Combination code 0295T describes all the components
(recording, scanning analysis with report, review and inter-
pretation). Codes 0296T0298T report the component
services separately, in case the services are performed by
different providers.
0296T External electrocardiographic recording for more than
48 hours up to 21 days by continuous rhythm recording and
storage; recording (includes connection and initial recording)
AAPC Rationale
New codes describe external electrocardiographic record-
ing for more than 48 hours, up to 21 days. Current codes
(9322492337) report similar recording when performed
up to 48 hours.
Report 0296T for recording only. If the same provider per-
forms recording, scanning analysis with report, review and
interpretation, report 0295T.
0297T External electrocardiographic recording for more than
48 hours up to 21 days by continuous rhythm recording and
storage; scanning analysis with report
AAPC Rationale
New codes describe external electrocardiographic record-
ing for more than 48 hours, up to 21 days. Current codes
Complete 2013 Procedure Updates 57
Complete 2013 Procedure Coding Updates
(9322492337) report similar recording when performed
up to 48 hours.
Report 0297T for scanning analysis with report only. If
the same provider performs recording, scanning analysis
with report, review and interpretation, report 0295T.
0298T External electrocardiographic recording for more than
48 hours up to 21 days by continuous rhythm recording and
storage; review and interpretation
AAPC Rationale
New codes describe external electrocardiographic record-
ing for more than 48 hours, up to 21 days. Current codes
(9322492337) report similar recording when performed
up to 48 hours.
Report 0298T for review and interpretation only. If the
same provider performs recording, scanning analysis with
report, review and interpretation, report 0295T.
0299T Extracorporeal shock wave for integumentary wound
healing, high energy, including topical application and dressing
care; initial wound
AAPC Rationale
Extracorporeal shock wave treatment (ESWT) has been
shown in the clinical setting to promote the healing of
burns and other difficult-to-heal wounds. Codes for
ESWT for wound healing are reported per wound. Claim
0299T for the initial wound.
0300T Extracorporeal shock wave for integumentary
wound healing, high energy, including topical application and
dressing care; each additional wound (list separately in addition
to code for primary procedure)
AAPC Rationale
Codes for ESWT for wound healing are reported for each
wound. Report +0300T for each additional wound, in
addition to 0299T for the initial wound.
0301T Destruction/reduction of malignant breast tumor
with externally applied focused microwave, including interstitial
placement of disposable catheter with combined temperature
monitoring probe and microwave focusing sensocatheter under
ultrasound thermotherapy guidance
58 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
AAPC Rationale
Code 0301T describes focused microwave thermotherapy
of the breast. Microwave applicators are placed on either
side of the compressed breast. A probe is placed within the
breast to monitor the interstitial temperature. The tech-
nique is based on the preferential microwave heating that
occurs in high-water content breast carcinoma, compared
to the surrounding lower water content healthy breast tis-
sues. The procedure includes imaging guidance.
Do not report 0301T with 76645, 76942, 76998, or
7760077615.
0302T Insertion or removal and replacement of intracar-
diac ischemia monitoring system including imaging supervision
and interpretation when performed and intra-operative inter-
rogation and programming when performed; complete system
(includes device and electrode)
AAPC Rationale
An intracardiac ischemic monitoring device system
includes a generator, adaptor, and transvenous lead. The
system detects and warns patients during a major ischemic
coronary event (eg, coronary plaque rupture). New codes
report insertion of the system, insertion of individual com-
ponents when the entire system is not inserted, removal of
the system, programming, and interrogation.
Report 0302T when the entire system is inserted or
replaced. The procedure includes interrogation and pro-
gramming.
0303T Insertion or removal and replacement of intracar-
diac ischemia monitoring system including imaging supervision
and interpretation when performed and intra-operative interro-
gation and programming when performed; electrode only
AAPC Rationale
An intracardiac ischemic monitoring device system
includes a generator, adaptor, and transvenous lead. The
system detects and warns patients during a major ischemic
coronary event (eg, coronary plaque rupture). New codes
report insertion of the system, insertion of individual com-
ponents when the entire system is not inserted, removal of
the system, programming, and interrogation.
Report 0303T when the electrode is inserted or replaced.
The procedure includes interrogation and programming.
= Service/Procedure Includes Moderate Sedation

0304T Insertion or removal and replacement of intracar-
diac ischemia monitoring system including imaging supervision
and interpretation when performed and intra-operative interro-
gation and programming when performed; device only
AAPC Rationale
An intracardiac ischemic monitoring device system
includes a generator, adaptor, and transvenous lead. The
system detects and warns patients during a major ischemic
coronary event (eg, coronary plaque rupture). New codes
report insertion of the system, insertion of individual com-
ponents when the entire system is not inserted, removal of
the system, programming, and interrogation.
Report 0304T when the device is inserted or replaced. The
procedure includes interrogation and programming.
0305T Programming device evaluation (in person) of intra-
cardiac ischemia monitoring system with iterative adjustment of
programmed values, with analysis, review, and report
AAPC Rationale
An intracardiac ischemic monitoring device system
includes a generator, adaptor, and transvenous lead. The
system detects and warns patients during a major ischemic
coronary event (eg, coronary plaque rupture). New codes
report insertion of the system, insertion of individual com-
ponents when the entire system is not inserted, removal of
the system, programming, and interrogation.
Report 0305T for programming and adjustments of the
system, including analysis, review, and report. The service
must be performed in person.
0306T Interrogation device evaluation (in person) of intra-
cardiac ischemia monitoring system with analysis, review, and
report
AAPC Rationale
An intracardiac ischemic monitoring device system
includes a generator, adaptor, and transvenous lead. The
system detects and warns patients during a major ischemic
coronary event (eg, coronary plaque rupture). New codes
report insertion of the system, insertion of individual com-
ponents when the entire system is not inserted, removal of
the system, programming, and interrogation.
Report 0306T for interrogation of the system, including
analysis, review, and report. The service must be per-
formed in person.
= FDA Approval Pending = Add-on
Complete 2013 Procedure Coding Updates
0307T Removal of intracardiac ischemia monitoring device
AAPC Rationale
An intracardiac ischemic monitoring device system
includes a generator, adaptor, and transvenous lead. The
system detects and warns patients during a major ischemic
coronary event (eg, coronary plaque rupture). New codes
report insertion of the system, insertion of individual com-
ponents when the entire system is not inserted, removal of
the system, programming, and interrogation.
Report 0307T when the device is removed without
replacement.
0308T Insertion of ocular telescope prosthesis including
removal of crystalline lens
AAPC Rationale
Code 0308T describes insertion and implantation of a
telescope into the lens capsule. The procedure is performed
on patients with central vision loss caused by end-stage,
age-related macular degeneration. Code 0308T is modifier
51 exempt.
0309T Arthrodesis, pre-sacral interbody technique, includ-
ing disc space preparation, discectomy, with posterior instru-
mentation, with image guidance, includes bone graft, when
performed, lumbar, L4-L5 interspace (list separately in addition
to code for primary procedure)
AAPC Rationale
The new code has been created to report pre-sacral inter-
body technique arthrodesis with posterior instrumentation.
Code 0309T includes the disc preparation, discectomy,
posterior instrumentation, imaging guidance, and bone
graft. Report 0309T when the procedure is performed at
the L4-L5 interspace.
This code is used with 22586. Do not report with 20930-
20938, 22840, 22848, 72275, 77002, 77003, 77011, or 77012.
0310T Motor function mapping using non-invasive navigated
transcranial magnetic stimulation (nTMS) for therapeutic treat-
ment planning, upper and lower extremity
AAPC Rationale
Report 0310T for motor function mapping accomplished
by combining transcranial magnetic stimulation (TMS)
and electromyography (EMG) with guidance, with mag-
netic resonance. The test is performed to identify func-
tional motor cortex prior to brain surgery.
Complete 2013 Procedure Updates 59
Complete 2013 Procedure Coding Updates
0311T Non-invasive calculation and analysis of central arte-
rial pressure waveforms with interpretation and report
AAPC Rationale
Code 0311T describes central arterial pressure waveforms
to evaluate patients with difficult-to-treat hypertension (eg
not responding to medication).
0312T Vagus nerve blocking therapy (morbid obesity);
laparoscopic implantation of neurostimulator electrode array,
anterior and posterior vagal trunks adjacent to esophagogastric
junction (EGJ), with implantation of pulse generator, includes
programming
AAPC Rationale
Vagal blocking employs a device to block hunger and
satiety signals from the vagus nerve. The procedure is per-
formed laparoscopically and does not alter the anatomy of
the stomach. A total of six Category III codes were created
to report the insertion of the system, revision or replace-
ment of the components of the system, removal of compo-
nents, and analysis and reprogramming.
Report 0312T for laparoscopic implantation of the neuro-
stimulator electrode array, pulse generator, and program-
ming.
0313T Vagus nerve blocking therapy (morbid obesity); lapa-
roscopic revision or replacement of vagal trunk neurostimulator
electrode array, including connection to existing pulse generator
AAPC Rationale
Vagal blocking employs a device to block hunger and
satiety signals from the vagus nerve. The procedure is per-
formed laparoscopically and does not alter the anatomy of
the stomach. A total of six Category III codes were created
to report the insertion of the system, revision or replace-
ment of the components of the system, removal of compo-
nents, and analysis and reprogramming.
Report 0313T for laparoscopic revision or replacement of
the electrode array, and connection to the existing pulse
generator.
60 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code
0314T Vagus nerve blocking therapy (morbid obesity); lapa-
roscopic removal of vagal trunk neurostimulator electrode array
and pulse generator
AAPC Rationale
Vagal blocking employs a device to block hunger and
satiety signals from the vagus nerve. The procedure is per-
formed laparoscopically and does not alter the anatomy of
the stomach. A total of six Category III codes were created
to report the insertion of the system, revision or replace-
ment of the components of the system, removal of compo-
nents, and analysis and reprogramming.
Report 0314T for laparoscopic removal of the electrode
array and pulse generator only.
0315T Vagus nerve blocking therapy (morbid obesity);
removal of pulse generator
AAPC Rationale
Vagal blocking employs a device to block hunger and
satiety signals from the vagus nerve. The procedure is per-
formed laparoscopically and does not alter the anatomy of
the stomach. A total of six Category III codes were created
to report the insertion of the system, revision or replace-
ment of the components of the system, removal of compo-
nents, and analysis and reprogramming.
Report 0315T for removal of the pulse generator only.
0316T Vagus nerve blocking therapy (morbid obesity);
replacement of pulse generator
AAPC Rationale
Vagal blocking employs a device to block hunger and
satiety signals from the vagus nerve. The procedure is per-
formed laparoscopically and does not alter the anatomy of
the stomach. A total of six Category III codes were created
to report the insertion of the system, revision or replace-
ment of the components of the system, removal of compo-
nents, and analysis and reprogramming.
Report 0316T for replacement of the pulse generator only.
= Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure Coding Updates

0317T Vagus nerve blocking therapy (morbid obesity); neuro-

stimulator pulse generator electronic analysis, includes repro-
gramming when performed
AAPC Rationale
Vagal blocking employs a device to block hunger and
satiety signals from the vagus nerve. The procedure is per-
formed laparoscopically and does not alter the anatomy of
the stomach. A total of six Category III codes were created
to report the insertion of the system, revision or replace-
ment of the components of the system, removal of compo-
nents, and analysis and reprogramming.

Report 0317T for electronic analysis and reprogramming

of the pulse generator.

0318T Implantation of catheter-delivered prosthetic aortic

heart valve, open thoracic approach, (eg, transapical, other
than transaortic)
AAPC Rationale
Procedures for the implantation of a prosthetic aortic
heart valve are reported based on approach. Report 0318T
when the procedure is performed using an open thoracic
approach. A parenthetical note directs you to 33361-33365
for other approaches.

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 61

 Complete 2013 ProcedurePractical
Coding Updates
Activity

Practical Activity
During this portion of the workshop, you will be coding five cases. These cases were selected to test new codes or coding
concepts for 2013. You will be given time to code the cases on your own. After you complete the cases, your presenter will
review the answers and rationales with you. For each case, select the appropriate CPT codes, and modifiers if applicable.

Case 1
DATE OF PROCEDURE: January 31, 2013

PROCEDURE PERFORMED:

1. Cervical cerebral arch angiography

2. Selective catheter placement, bilateral common carotid artery
3. Selective innominate and bilateral carotid, cervical, and intracervical angiography

BRIEF HISTORY OF PRESENT ILLNESS: This is a 67-year-old Caucasian female who presented with abnormal Doppler
study with outpatient carotid bruit. She underwent cardiac vascular consultation, and elected to proceed with carotid angi-
ography to accurately assess disease severity and plan for management. Carotid velocities were 317/132 cm per second with
a ratio of 4.88. Left internal carotid velocities were 166/67 cm per second with a ratio of 1.58. Bilateral vertebral artery
flow direction with antegrade and normal.

Informed consent was obtained. The risk/benefit ratio of the procedure was explained. On arrival to the lab, the patient
was in pain-free, hemodynamically stable condition. A 5-French sheath was placed in right common femoral artery over
a J-wire. A pigtail catheter was advanced and was parked in the ascending aorta and 25 mL of contrast was injected at 20
mL per second and a cerebral arch angiography was performed.

Subsequently, a Bernstein-2 catheter was advanced and sequentially placed with the help of a Glidewire in the innominate,
right common, and left common carotid artery, selective innominate, bilateral cervical carotid, and intracerebral carotid
angiography was performed using diluted Visipaque dye injection. Complications were none immediate.

FINDINGS: This is a type 2 (B) arch with a slight downward displacement of innominate artery and left common carotid
artery. Innominate artery is widely patent and bifurcates normally into the subclavian and common carotid artery. Subcla-
vian artery has mild, non-obstructive plaque and gives rise to dominant vertebral and internal mammary artery, which are
unremarkable.

The right common carotid artery is free of significant disease.

The right internal carotid artery at its origin has complex hazy 90 percent grade stenosis. There is a faint contrast line, and
it appears there is significant calcification on the back wall of this vessel. The remainder of the cervical internal carotid
artery is unremarkable. Right external carotid artery has mild non-obstructed plaque at its origin.

Intracerebral right angiography reveals unremarkable intracerebral internal carotid artery sub-segments and normal cere-
bral artery and middle cerebral artery. No intracerebral aneurysms are identified. Capillary phases and venous phases are
unremarkable.

The left common carotid artery has non-obstructing plaque at its origin.

The left carotid bulb has out-pouching and a small contained ulcerated area. The left internal carotid artery at its origin
has 60 percent smooth excentric stenosis. The remainder of the left cervical and intracerebral internal carotid artery are
unremarkable.

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The left middle cerebral and internal carotid arteries are unremarkable.

Vertebral artery angiography was not performed due to lack of any posterior fossa symptoms.

Subclavian artery was unremarkable.

All the equipment was removed and access site hemostasis was achieved with manual compression.

IMPRESSION: Critical right internal carotid artery and moderate-grade left internal carotid artery stenosis.

CPT code(s): ____________________________________________________________

Case 2
CARDIOPULMONARY SERVICES/CATHETERIZATION LABORATORY REPORT

DATE OF PROCEDURE: 7/10/13

PROCEDURES PERFORMED:

1. Rotational atherectomy of the mid left anterior descending utilizing a 1.5- mm bur.
2 Cutting balloon atherectomy of the mid left anterior descending,
3. Intracoronary stent placement utilizing a 3.5 x 23 Promus stent in the mid left anterior descending.
4. Percutaneous transluminal coronary angioplasty of the first diagonal branch.
5. Intravascular ultrasound-guided percutaneous coronary intervention of the left anterior descending.

CLINICAL PROFILE: This is an 87-year-old man with a history of angina and complex two-vessel coronary artery disease,
referred for intervention.

PROCEDURAL DETAILS: Pre-procedure informed consent was obtained. The patient was brought to the cardiac catheter-
ization laboratory and sedated with low doses of Versed and Fentanyl, as detailed in the event log. Using standard sterile
percutaneous technique and local administration of 2 percent lidocaine, the right femoral artery was entered with an #8Fr.
short sheath. IV Angiomax was begun. We then advanced an #8Fr. XB 3.5 guiding catheter but this would not engage
the left main trunk, which arose low off a very long and dilated ascending aorta. A total of nine different guides were then
attempted in a series without successfully cannulating the left main trunk. Ultimately, we switched out the short sheath
for a long #8Fr. sheath, as it appeared that tortuosity in the iliacs was in part impeding our ability to manipulate guide
and cannulate the vessel. After this and utilizing a #7Fr. XB-5 guide, we were successfully able to cannulate the left main
trunk, although guide support was mediocre. Please see the event log for a detailed list of the guide catheters. Altogether, it
took 38 minutes to cannulate the left main trunk. We then advanced a short Runthrough wire into the apex of the LAD.
There was an obvious, complex, calcified lesion in the mid vessel. We attempted to pre dilate this with a cutting balloon,
but this balloon would not cross the lesion. We then pre dilated the mid LAD with a 2.5 Voyager balloon. Following this,
we again tried to advance the cutting balloon across the lesion but this was not successful. We therefore advanced a Rotab-
lator GoldWire into the distal LAD and removed the Runthrough wire. The mid LAD was rotablated with a 1.5-mm burr.
Following this, we successfully advanced the Cutting balloon. This was a 3.0 X 10 Cutting balloon. We then performed
baseline IVUS with an Eagle Eye ultrasound catheter. A 3.5 x 23 Pronmus stent was then advanced across the lesion and
deployed successfully. The first diagonal branch was subtotally occluded after stenting the LAD and was noted to be 90
percent at baseline. A Whisper ES wire was then advanced into the first diagonal branch. We then attempted to pass a 2.0
x 12 Sprinter balloon in the first diagonal branch and it would not cross. A 1.5 x 12 Maverick Fire Star balloon, crossed
with difficulty and multiple balloon inflations were obtained. We then advanced a 2.0 x 12 Quantum balloon and per-
formed additional balloon dilations with an excellent result. We then performed post procedure IVUS of the LAD and
this showed adequate stent expansion. Final angiograms were then performed with all devices removed, and the patient

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returned to the holding area in stable condition. Total fluoroscopic time was 30 minutes. He was loaded with Plavix post
procedure. He will be observed overnight. Sheath management will be per protocol on the floor.

ANGIOGRAPHIC FINDINGS: Left Selective Coronary Angiography: Left selective coronary angiograms demonstrate a supe-
riorly-directed left main trunk which arises low in the aortic root. The LAD shows moderate ostial disease of 50 percent or
less severity. A 90 percent stenosis is present in the mid LAD. This is complex calcified lesion arising between the first and
second diagonal branches. The first diagonal branch shows 90 percent baseline stenosis. Following intervention, there is
zero percent residual stenosis in the LAD, and a 20 percent or less residual stenosis in the first diagonal branch. A 60 per-
cent stenosis in the LAD beyond the stent is to be treated medically. There is TIMI grade-III flow post procedure.

FINAL SUMMARY: Successful but technically difficult interventional procedure to the mid left anterior descending, involv-
ing the combination of Rotablator, cutting balloon atherectomy, and stenting.

CPT code(s): ___________________________________________________________________________

Case 3
I discussed the procedure, risks, benefits, and alternatives regarding placement of a chest tube with the patient prior to the
procedure. Patient understood and consented to the procedure.

SHORT HISTORY INDICATIONS FOR OPERATION: Female had a horseback riding accident yesterday and over the last day
has acquired a pneumothorax, which has been enlarging. It became very large, at least a 50 percent, maybe more, pneu-
mothorax later this morning. Because it was enlarging and getting to the point of being dangerous, I felt that a small chest
tube would be indicated to expand the lungs and to decrease the chance of a complete collapse of her lung.

ANESTHESIA: Of note; also 1 gram of Ancef was given preprocedure for coverage.

DESCRIPTION OF PROCEDURE: The patient was placed in the right lateral decubitus position and the area was prepped
and draped. Under sterile conditions a #12 French chest tube was placed in the left lateral chest wall as high as could be
and the chest tube going over the rib, approximately the 3 to 4 rib that the chest tube went over. It was placed into posi-
tion. I felt with my finger and felt no lung material, only the fluid that I pushed through and the chest tube was placed
easily in the proper position. If was sewn in place using 2-0 silk suture. Chest tube was placed on suction and in the recov-
ery room, a post chest tube chest x-ray was taken and it shows that the lung has expanded to near completion and the chest
tube is in proper position. The patient was brought to the recovery room in stable condition.

CPT code(s): ___________________________________________________________________________

Case 4
PROGRESS NOTE: Pharmacologic Management

SUBJECTIVE/OBJECTIVE: The patient brought in lab results he recently had done at the hospital from his physician, show-
ing he had CBC, kidney function test, blood sugar, liver function test, and thyroid function test that were within normal
limits, and his total cholesterol was 188. His HDL was 53. His LDL was 119 and his triglycerides were 78. The patient says
he is feeling well. He has good focus and is working well. The only thing he is requesting is to go back to the immediate
release Ritalin because of the cost. He says he is a bit short of money, although he knows that the Ritalin IR does not work
as well for him, he wants to try that again. His energy is good. His sleep is good.

MENTAL STATUS EXAMINATION: Shows a gentleman who looks his stated age. He is cooperative and pleasant. Has good
eye contact. His mood is euthymic. His affect is congruent. He denies auditory or visual hallucinations, suicidal or homi-
cidal ideations. He denies delusions. He is alert and oriented x 4.

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PLAN: As per patients request, we will switch over to Ritalin Immediate Release 40 mg bid because of cost, #60. I gave
him a prescription with todays date, not to be filled until September 24 and I noted that on the prescription, because the
patient had his last prescription called on August 24, 2013.

Prescription: Ritalin IR 40 mg bid #60, no refills, to be filled only on September 24, 2013.

Follow Up: The patient is to follow up in the office in six weeks.

M Smith, MD

CPT code(s): ___________________________________________________________________________

Case 5
PREOPERATIVE DIAGNOSIS:
1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture
2. Right Shoulder Chronic Anterior Inferior Dislocation

POSTOPERATIVE DIAGNOSIS:
1. Right Shoulder Failed Hemiarthroplasty for Superior Proximal Humerus Fracture
2. Right Shoulder Chronic Anterior Inferior Dislocation

NAME OF PROCEDURE:
1. Right Shoulder Arthroplasty Revision
2. Right Shoulder Anterior Capsular Shift

ANESTHESIA: General
PREOPERATIVE PREAMBLE: This patient is a delightful female who has a right shoulder anterior inferior dislocation with
loosening of the soft tissue anteriorly. This is a chronic condition. I have counseled this patient at length regarding the
natural history of this problem, as well as potential risks, complications, and benefits of surgical versus nonsurgical man-
agement. The patient and the patients family state they understand the risks include, but are not limited to, infection,
component loosening, dislocation, injury to myotendinous units, injury to neurovascular bundles, deep venous thrombosis,
pulmonary embolus, anesthesia problems, and even death. She has been given no warranties, no guarantees, no promises.
Full informed consent has been obtained.

The patient was taken to the operating room and in the supine position successfully induced with a general anesthesia
using endotracheal intubation. After adequate analgesia was obtained, the right shoulder was prepped and draped in the
usual sterile fashion, standard deltopectoral interval approach was used to incise the epidermis, dermis, and subcutaneous
tissue with a #10 blade. The dissection was carried down through the deltopectoral interval, then the clavipectoral interval
was then entered, gaining access to the joint. The patient had a large redundant anterior joint capsule, thick and fibrotic
material. The patient was also found to have a component, which had subsided some and loosened some. Therefore, it was
removed, as well as a portion of the proximal cement mantle in the proximal humerus.

I then debrided the intraarticular aspect of the joint, removing any obstructive fibrious tissue and obstructive debris, gain-
ing access to the glenoid, which was found to have some minimal degenerative change but no significant arthritis. The
labrum was also somewhat atrophied anteriorly but was largely intact.

I removed the existing humeral component and I resized the component for a smaller diameter component, which would
allow cementing into the preexisting cement mantle. I also over retroverted the components to try to prevent further ante-
rior interior dislocation. I gained length through the soft tissue envelope, approximately 2 cm, which should also keep

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the component from moving inferiorly, therefore by retroversion and lengthening I was able to create significant stability.
The final component was opened, which was 2 mm smaller in diameter than the original component, giving an adequate
cement mantle. I cemented into the original cement mantle with more retroversion and more length. When the cement
dried, the shoulder was reduced and found to be stable.

I then performed an anterior capsulorrhaphy, capsular tightening, capsular shift by bringing up the anterior interior cap-
sule material and taking away the redundancy anteriorly and inferiorly. This was done with multiple interrupted sutures.
The wound was then copiously irrigated and closed in standard fashion. Sterile dressing was placed over the wounds. At
the end of this procedure, the sponge, needle, and instrument counts were correct. This procedure was completed without
event. Patient is now convalescing without event in the recovery room.

CPT code(s): ___________________________________________________________________________

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 Complete
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ActivityAnswers
Procedure Coding
and Rationales
Updates

Practical Exercise Answer Key and Rationales

Case 1
CPT code(s): 36223-50
Rationale: Look in the CPT index for Angiography/Common Carotid/Selective Catheterization (36222, 36223). Selec-
tive catheterization of the right common carotid was followed by angiography and interpretation of the right common
carotid, right external carotid, right internal carotid and the right intracerebral arteries (36223). Selective catheterization
of the left common carotid was followed with angiography and interpretation of the left common carotid, the left inter-
nal carotid, and left intracerebral arteries, which again is code 36223. The left and right external carotid angiography
was not performed; however, the descriptor indicates it is included when performed. Arch angiography is also included
in this code. Modifier 50 is appended to indicate a bilateral procedure. The documentation notes that the right subcla-
vian has mild non-obstructive plaque and right internal mammary is normal. The left subclavian artery was unremark-
able. This is included in the arch angiography, which is bundled. Do not report 36215-59, 75716-26. The final code
selection is 36223-50.

Case 2
CPT code(s): 92933-LD, 92921-LD, 92978

Rationale: Angioplasty, followed by atherectomy, then stent placement in the LD was performed. Report only the most
intensive procedure, which is the atherectomy. New combination codes were created to report atherectomy, stent, and
angioplasty performed in the same major coronary artery. See 9293392934. This was a single major coronary artery
reported with 92933. Modifier LD is appended for the left anterior descending artery. Next report the angioplasty of the
first diagonal branch of the LD. Look in the CPT index for Angioplasty/Coronary Artery/Percutaneous Transluminal
9292092921. This is an additional branch of the left anterior descending; therefore, add-on code 92921-LD is correct.
Next, report the IVUS. Look in the CPT index for Vascular Procedures/Intravascular Ultrasound/Coronary Vessels
9297892979. Although IVUS was used pre- and post-procedure, it is only reported once per vessel. You might have con-
sidered adding modifier 22 Increased procedural service because it took 38 minutes to cannulate the left main trunk and the
case was difficult; however, the documentation does not substantiate that the case took much longer and was more difficult
than usual. Do not report moderate sedation. The bullseye next the codes indicate it is included (further, no time is listed
for moderate sedation).

Case 3
CPT: 32556-LT
Rationale: This is the placement of a chest tube. Look in the CPT index for Insertion/Catheter/Pleural Cavity 32550,
32556. Image guidance was not performed to place the tube. The correct code is 32556 Pleural drainage, percutaneous, with
insertion of indwelling catheter; without imaging guidance.

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and Rationales
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Case 4
CPT code(s): 99212
Rationale: The new pharmacologic management code (90863) is an add-on code that may be reported only with psycho-
therapy services; psychotherapy services were not provided. According to the coding guidelines, providers who are permit-
ted should report the service with E/M codes. The provider rendering the service is an MD; therefore, you would select the
appropriate E/M code using the three key components (history, exam, and medical decision making).

The provider documented:

Problem focused history: brief HPI, problem focused ROS
Expanded problem focused exam: limited exam of 2-7 body areas and/or organ systems (1995) or a problem focused exam
for 1997 Psychiatric Exam (4 elements)
Straightforward MDM: One established stable diagnosis, one data point (review of labs), moderate risk (prescription drug
management). Only 2 of the 3 key components are needed; however, this will not change the assignment of 99212.

Case 5
CPT code(s): 23473-RT
Rationale: The procedure preformed is the revision of an arthroplasty of the shoulder. From the CPT index, look up Revi-
sion/Shoulder. You are referred to Arthroplasty/Shoulder Joint, which directs you to 23470, 2347223474. The code is
selected based on whether the procedure involves the humeral and/or glenoid component. The description of the procedure
states the humeral component was removed and replaced (23473). Debris was removed from the glenoid but the compo-
nent did not require revision. According to the NCCI edits an anterior capsulorrhaphy is bundled with shoulder arthro-
plasty; therefore, it is not reported separately. The notes for 23473 instruct not to report 23331 Removal of foreign body,
shoulder; deep with 23473

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 Complete 2013 Procedure
Slide
Coding
Presentation
Updates

Slide Presentation

2013CPTCodingUpdates

Presentedby:RaemarieJimenez,CPC,CPMA,
CPCI,CANPC,CRHC
DirectorofEducation
CowrittenbyJohnVerhovshek,CPC

CPTDisclaimer
CPTcopyright2012AmericanMedicalAssociation.Allrights
reserved.

Feeschedules,relativevalueunits,conversionfactorsand/or
relatedcomponentsarenotassignedbytheAMA,arenotpart
ofCPT,andtheAMAisnotrecommendingtheiruse.TheAMA
doesnotdirectlyorindirectlypracticemedicineordispense
medicalservices.TheAMAassumesnoliabilityfordata
containedornotcontainedherein.

CPTisaregisteredtrademarkoftheAmericanMedical
Association.

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Objective
OverviewoftheNew,RevisedandDeletedCPT
codesfor2013
Reviewdocumentationrequirementsforthenew
codes
Handsonexercisestopracticeusingthenewand
revisedcodes

CodeChangesNowWhat?
Review2013CPTcodechanges,usingthis
guide
Order2013codebooks
Reviewallchangestoguidelines,notesand
instructionsinyourbook
Highlightchangesinthebooksindex
pertinenttoyourspecialtyandreviewthose
changes

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 Complete 2013 Procedure
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CodeChangesNowWhat?
Highlightchangesinthetabularsectionpertinentto
yourspecialty
Createadocumentationcheatsheetof2013
updatesthatmustbedocumenteddifferentlyfor
coderstocapturetheinformationneededand
distributeittoclinicians
Reviewandupdatesuperbills,chargemasters,etc.
Runutilizationreportofthedeletedandrevised
codes.

CodeChangesNowWhat?
Uploadsoftwarechange
Traincodingandbillingstaffonchanges
Checkforaddendaorerrata(www.ama
assn.org/resources/doc/cpt/cptcorrectionserrata.pdf)
ReviewPQRSchanges
Communicatewithpayer/providerreps
regardingreimbursementandcoverageissues
Archivelastyearsbooks

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TimeDefined
TimedefinedintheIntroduction
Usethefollowingcriteriaunlesssectionor
subsectionguidelinesinstructotherwise
Timeismetwhenthemidpointispassed
Codesreportinganhourrequireaminimumof31
minutestoreportthecode
Donotreporttimeperformingaconcurrent
service
Example:deductthetimespentperformingbillable
services(eg,CPR)fromcriticalcaretime

E/MChanges
82E/Mcodesrevisedtoincludeotherqualified
healthcareprofessionals
Example:Descriptorrevisionsfor99201

Counselingand/orcoordinationofcarewithotherphysicians,
otherproviders qualifiedhealthcareprofessionals,or
agenciesareprovidedconsistentwiththenatureofthe
problem(s)andthepatientsand/orfamilysneeds.Usually,
thepresentingproblem(s)areselflimitedorminor.Physicians
typicallyspend Typically,10minutesarespentfaceto face
withthepatientand/orfamily.
8

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E/MChanges
OtherQualifiedHealthCareProfessionals
CPTcodedescriptionchangedtodescribethe
service,nottheproviderperformingtheservice
CPTcodesareusedbyotherprovidersnotjust
physicians
Examples:
Outpatienthospitals/ASC
Nursepractitioners/PhysicianAssistants
PhysicalTherapist/OccupationalTherapist

E/MChanges
OtherQualifiedHealthCareProfessional
StateScopeofPractice
FacilityRequirements
PayerPolicies
MedicareClaimsProcessingManual

10

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PediatricCriticalCareTransport
Newcodesreportservicesprovidedbythe
controlphysicianduringaninterfacility
transport
99485and99486
Basedontime
Patients24monthsofageoryounger
Mustbecriticallyillorcriticallyinjured

11

PediatricCriticalCareTransport
Servicesinclude:
Twowaycommunicationwithtransportteam
Time
Beginswhenthecontrolphysicianfirstcontacts
thetransportteam
Endswhenpatientcareistakenoverbythe
receivingfacility

12

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PediatricCriticalCareTransport
Donotreport:
Servicesperformedbythetransportteam
Pretransportcommunicationtimewithreceiving
facility
Directfacetofacetransport(99466,99467)with
99485,99486

13

ComplexChronicCareCoordinationServices
Forclinicalstafftimedirectedbyaphysician
orotherqualifiedhealthcareprovider
Reportedforcoordinationofservices(medical
andpsychosocial)
Timebased
Reportedpercalendarmonth
Basedonwhetherpatienthasfacetoface
encounterduringthemonth

14

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ComplexChronicCareCoordinationServices

Clinicalindicationsthatqualify:
Oneormorechronicillnessesexpectedtolastat
least12months
Acuteexacerbationordecompensation
Functionaldecline
MedicalDecisionMakingmustbemoderateor
high

15

ComplexChronicCareCoordinationServices

Documentationmustinclude:
Conditionofthepatient
Totaltimespentperformingcoordinationservices
forcomplexchroniccare
Basedonclinicalstafftime
Ifphysicianperformscoordinationservices,thetimeis
addedtotheclinicalstafftimetosupportthecode

16

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 Complete 2013 Procedure
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ComplexChronicCareCoordinationServices

Facttofaceencounter(during
calendarmonth)

Yes No

99489(each 99489(each
99488(first 99487(first
additional30 additional30
hour) hour)
minutes) minutes)

17

ComplexChronicCareCoordinationServices
PatientDiagnosis:MultipleSclerosisandCOPDexacerbation

Date Time ServicesCoordinated

1/10/13 20minutes ContactedHomeHealthtoarrangeforoxygeninthe
patientshome.Patientisscheduledtoreceivetheoxygen
thisafternoon.TheCMNwascompletedandsenttothe
homehealthagency.Discussedthearrangementsand
properuseofoxygenwiththepatientsdaughter.Patient
anddaughterunderstand
1/15/13 15minutes Patientsdaughtercalledstatingthepatientisdepressed
duetothelimitationssheisexperiencingduetotheMS.
Arrangedforthepatienttoseepsychologistandevaluation
fromPTtoseeiftherecanbeanyimprovementinmobility.

18

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ComplexChronicCareCoordinationServices

Donotreportwith
Careplanoversight(99339,99340,9937499380)
Prolongedserviceswithoutdirectcontact(99358,
99359)
Anticoagulantmanagement(99363,99364)
Medicalconferenceteam(9936699368)
Educationandtraining(9896098962,99071,
99078)
Telephoneservices(9896698968,9944199443)
19

ComplexChronicCareCoordinationServices

Donotreportwith
Onlinemedicalevaluationservices(9896999444)
Preparationofspecialreports(99080)
Analysisofdata(99090,99091)
Transitionalcaremanagement(99495,99496)
Medicationtherapymanagementservices(99605
99607)
ESRDservices(9095190970)

20

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TransitionalCareManagementServices

Reportedfortransitionalcareforpatients
dischargedfromthehospital,SNF,rehab
hospital,partialhospitalorobservationto
home,domiciliary,resthomeorassistedliving
Propertransitionalcareisimportantto
preventrepeatadmissions
Reportedbyphysicianorotherqualified
healthcareprovider.Canbereportedbythe
sameindividualwhodischargedthe
21

TransitionalCareManagementServices

Documentationmustinclude:
Contactwiththepatient(telephoneorelectronic)
withintwobusinessdaysofdischarge
DocumentationtosupportMDM
99495requiresatleastmoderateMDM
99496requireshighMDM
Facetofacevisit
99495within14businessdays
99496within7businessdays

22

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TransitionalCareManagementServices

MDM Facetoface Facetoface

visitwithin7 visitin8to14
days days
Moderate 99495 99495
High 99496 99495

23

TransitionalCareManagementServices
Documentationshouldinclude:
Dateofthepatientsdischarge
Initialpatientcontactwithin2days(phoneor
email)
MDMmustbedocumented
RefertotheMDMcriteriausingtheCPTcoding
guidelinesor1995/1997CMSDocumentation
Guidelines
Documentedfacetofaceencounter
DonotreportaseparatecodefortheE/M

24

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TransitionalCareManagementServices

Donotreportwith
Careplanoversight(99339,99340,9937499380)
Prolongedserviceswithoutdirectcontact(99358,
99359)
Anticoagulantmanagement(99363,99364)
Medicalconferenceteam(9936699368)
Educationandtraining(9896098962,99071,
99078)
Telephoneservices(9896698968,9944199443)
25

TransitionalCareManagementServices

Donotreportwith
ESRDservices(9095190970)
Onlinemedicalevaluationservices(9896999444)
Preparationofspecialreports(99080)
Analysisofdata(99090,99091)
Complexchroniccarecoordination(9948799489)
Medicationtherapymanagementservices(99605
99607)

26

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Anesthesia
01991Anesthesiafordiagnosticortherapeutic
nerveblocksandinjections(whenblockorinjection
isperformedbyadifferentprovider physicianor
otherqualifiedhealthcareprofessional);otherthan
theproneposition

Samechangeismadeto01992
Revisiontoincludeotherqualifiedhealthcare
professionals

27

Integumentary
15740Flap;islandpediclerequiring
identificationanddissectionofan
anatomicallynamedaxialvessel

Revisionmadetoclarifypropercodeuse
becausereasontobelievecodeismisused
Mostcommonlyreportedwithskin
malignancydiagnosis

28

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Integumentary
Documentationforislandpedicleflap
Islandofskinisdetachedfromitsepidermaland
dermalattachmentswhileretainingitsvascular
supply(anatomicallynamedaxialvessel)
Mostcommonlyusedonthelipandnose

29

Musculoskeletal
20665Removaloftongsorhaloappliedby
anotherphysician individual
Revisiontoremovephysicianastheonlyprovider

+22522Percutaneousvertebroplasty
Includesmoderatesedation
22520and22521alreadyincludedmoderate
sedation

30

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2013 Procedure Coding Updates

Musculoskeletal
22586Arthrodesis,presacralinterbody
technique,includingdiscspacepreparation,
discectomy,withposteriorinstrumentation,
withimageguidance,includesbonegraft
whenperformed,L5S1interspace

31

Musculoskeletal
Documentationfor22586
Unlikeotherspinecodes,thiscodeisspecificto
theinterspace(L5S1)
Posteriorinstrumentationrequired
Imagingguidancecannotbereportedseparately

32

86 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Presentation
Updates

Musculoskeletal
23473Revisionoftotalshoulderarthroplasty,
includingallograftwhenperformed;humeral
or glenoidcomponent

23474Revisionoftotalshoulderarthroplasty,
includingallograftwhenperformed;humeral
and glenoidcomponent

33

Musculoskeletal
Documentationfor23473
Revisionofapreviousshoulderarthroplasty
Includestheremovalofpreviousplacedcomponents
Humeralor glenoidcomponent
Documentationfor23474
Revisionofapreviousshoulderarthroplasty
Includestheremovalofpreviousplacedcomponents
Humeraland glenoidcomponent

34

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Musculoskeletal
24370Revisionoftotalelbowarthroplasty,
includingallograftwhenperformed;humeral
or ulnarcomponent
24371Revisionoftotalelbowarthroplasty,
includingallograftwhenperformed;humeral
and ulnarcomponent

35

Musculoskeletal
Documentationfor24370
Revisionofapreviouselbowarthroplasty
Includestheremovalofpreviousplacedcomponents
Humeralor ulnarcomponent
Documentationfor24371
Revisionofapreviouselbowarthroplasty
Includestheremovalofpreviousplacedcomponents
Humeraland ulnarcomponent

36

88 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Presentation
Updates

Musculoskeletal
28890Extracorporealshockwave,highenergy,
performedbyaphysicianorotherqualifiedhealth
careprofessional,requiringanesthesiaotherthan
local,includingultrasoundguidance,involvingthe
plantarfascia
Revisiontoremovephysicianastheonlyprovider

37

Musculoskeletal
29590 DenisBrownesplintstrapping
Nolongerperformed

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2013 Procedure Coding Updates

Respiratory
Newcodes3164731651replaceCategoryIIIcodes
0250T0252Tforinsertion/removalforbronchial
valves
Bronchialvalvesareinsertedtotreatpatientswith
emphysemaorlungdamage
Valveslimitairflowtothedamagedpartofthelungtopromote
healing
Thereareatotaloffivelobesinthelungs
Twolobesintheleftlung
Threelobesintherightlung
Proceduresincludeconscioussedation

39

Respiratory
31647Bronchoscopy,rigidorflexible,including
fluoroscopicguidance,whenperformed;with
balloonocclusion,whenperformed,assessmentof
airleak,airwaysizing,andinsertionofbronchial
valve(s),initiallobe
31648Bronchoscopy,rigidorflexible,including
fluoroscopicguidance,whenperformed;with
removalofbronchialvalve(s),initiallobe

40

90 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Respiratory
+31649Bronchoscopy,rigidorflexible,includingfluoroscopic
guidance,whenperformed;withremovalofbronchial
valve(s),eachadditionallobe(listseparatelyinadditionto
codeforprimaryprocedure)
+31651Bronchoscopy,rigidorflexible,includingfluoroscopic
guidance,whenperformed;withballoonocclusion,when
performed,assessmentofairleak,airwaysizing,andinsertion
ofbronchialvalve(s),eachadditionallobe(listseparatelyin
additiontocodeforprimaryprocedure[s])

41

Respiratory
DocumentationRequirements3164731651
Insertionofvalves
Howmanylobes
Removalofvalves
Howmanylobes

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2013 Procedure Coding Updates

Respiratory
Bronchographyisnolongerperformed
Deletedcodesinclude:
31656Bronchoscopy,rigidorflexible,including
fluoroscopicguidance,whenperformed;with
injectionofcontrastmaterialforsegmental
bronchography(fiberscopeonly)
31715Transtrachealinjectionfor
bronchography
ComputedTomography(CT)isthecurrent
standardofcare
43

Respiratory
CategoryIIIcodes0276T0277Thavebeen
deletedandreplacedwithnewcodes(31660
31661)forbronchialthermoplasty
Usesradiofrequencyablationtotreatasthmatic
patients
Reducesthemuscleassociatedwithairway
constriction
Proceduresincludeconscioussedation

44

92 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Respiratory
31660Bronchoscopy,rigidorflexible,
includingfluoroscopicguidance,when
performed;withbronchialthermoplasty,1
lobe
31661Bronchoscopy,rigidorflexible,
includingfluoroscopicguidance,when
performed;withbronchialthermoplasty,2or
morelobes

45

Respiratory
Documentationfor31660,31661
Thermoplasty:therapeuticradiofrequencyenergy
usedtoheatandreducethetissueofsmooth
musclepresentintheairwaywall
Ifperformedononelobe,report31660
Ifperformedontwoormorelobes,report31661
Thecodesincludefluoroscopicguidanceand
conscioussedation

46

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Respiratory
32420Pneumocentesis,punctureoflungfor
aspiration
Nolongerperformed
Directedtouse32405Biopsy,lungor
mediastinum,percutaneousneedle

47

Respiratory
32421Thoracentesis,punctureofpleuralcavityfor
aspiration,initialorsubsequent
Deleted
See32554/32555
32422Thoracentesiswithinsertionoftube,includes
waterseal(eg,forpneumothorax),whenperformed
(separateprocedure)
Deleted
See32554/32555

48

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Updates

Respiratory
32551Tubethoracostomy,includeswater
seal connectiontodrainagesystem (eg,for
abscess,hemothorax,empyema waterseal),
whenperformed,open (separateprocedure)
Clarifyaccess
Openprocedure
Conditionsremovedsoasnottolimitusetoonly
abscess,hemothorax,empyema
Includesconscioussedation

49

Respiratory
32554Thoracentesis,needleorcatheter,
aspirationofthepleuralspace;withoutimaging
guidance
32555Thoracentesis,needleorcatheter,
aspirationofthepleuralspace;withimaging
guidance
Aneedleorcatheterisusedtopuncturethepleuralspace
andwithdrawfluid
Replace32420/32422
Selectcodesbasedonwhetherimagingguidanceis
performed
50

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Respiratory
Documentationrequirements32554,32555
Surgicalpunctureanddrainageofthepleural
space
Thecatheterorneedleisnotleftinovertime
Thepunctureisperformedandthefluidisaspirated
Codeselectionbasedonwhetherimaging
guidanceisperformed
Donotreportaseparatecodefortheimaging

51

Respiratory
32556Pleuraldrainage,percutaneous,with
insertionofindwellingcatheter;withoutimaging
guidance
32557Pleuraldrainage,percutaneous,with
insertionofindwellingcatheter;withimaging
guidance

52

96 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Respiratory
Documentationrequirements32556,32557
Reportspercutaneousdrainageofpleuralfluid
Ifperformedasanopenprocedurereport32551
Tubeorcatheterisleftinplace(unlike
thoracocentesis)
Codeselectionisbasedonwhetherimaging
guidanceisused
Donotreportaseparatecodefortheimaging

53

Respiratory
32701Thoracictarget(s)delineationfor
stereotacticbodyradiationtherapy
(SRS/SBRT),(photonorparticlebeam),entire
courseoftreatment
Newsubsectionandguidelines
Performedtoidentifytumorborders,volumeand
relationshiptoadjacentanatomicstructures
Donotreportwith7742777499
Reportonlyoncepercourseoftreatment

54

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Cardiovascular
+33225Insertionofpacingelectrode,cardiac
venoussystem,forleftventricularpacing,attimeof
insertionofpacingcardioverter defibrillatoror
pacemakerpulsegenerator(including eg,for
upgradetodualchambersystemandpocket
revision)(Listseparatelyinadditiontocodefor
primaryprocedure)
revisedtoremovepocketrevisionasarequirement
parentheticalnoteshavebeenaddedtoinstructwhenitis
appropriatetoreport33225withotherprocedures

55

Cardiovascular
CategoryIIIcodes0256T,0258Tand0259Tdeleted
andreplacedby3336133367forTAVR
noninvasiveproceduretoreplacetheaorticvalvefor
patientswithaorticstenosis(narrowingoftheaorticvalve)
Servicesinclude:
Gainingaccess
Deploymentandrepositioningofthevalve
Temporarypacemakerinsertionforrapidpacing
Closureofarteriotomy
Angiography
Radiologicsupervisionandinterpretation

56

98 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Cardiovascular
3336133367,cont
Twoprovidersarerequiredforthisprocedure(eg,
cardiologist,interventionalradiologists)
Whentwosurgeonsworktogethertoperformtheseprocedures,
appendmodifier62
Diagnosticcoronaryangiographymaybereported
separatelywhen:
apriorcoronaryangiographywasnotperformed
ifapriorcoronaryangiographywasperformed,thetestisnot
adequate(eg,patientsconditionhaschangedsincetheoriginal
angiography,theinitialstudyisinadequatevisualizationof
anatomy)

57

Cardiovascular
3336133367,cont
Codesselectionisbasedon
whethertheapproachisopenorpercutaneous
thevesselthesurgeonusesfortheapproach
Cardiopulmonarybypassmaybereported
withtheappropriateaddoncode(33367
33369),dependingonthetypeofaccess
performed

58

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2013 Procedure Coding Updates

Cardiovascular
33361
percutaneousapproach
femoralartery
33362
openapproach
femoralartery
33363
openapproach
axillaryartery

59

Cardiovascular
33364
openapproach
iliacartery
33365
transaorticapproach
openprocedureviamediansternotomyor
mediastinotomy

60

100 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Cardiovascular
Addons3336733369report
cardiopulmonarybypassduringaTAVR
Selectcodesbasedonwhetherthecannulationis
performedpercutaneously,openorcentrally
+33367percutaneousperipheralarterialand
venouscannulation
+33368openperipheralarterialandvenous
cannulation
+33369centralarterialandvenouscannulation

61

Cardiovascular
Newcodes3399033993describeinsertion,removal
andrepositioningofpercutaenousventricleassist
devices(pVAD)
ReplacecategoryIIIcodes0048Tand0050T
Ventricleassistdevicesassistthepatientsheartto
pumpbloodduringhighriskproceduresorfor
criticallyillpatients
CodingguidelineshavebeenaddedtoHeart
(IncludingValves)andGreatVessels,CardiacValves
andCoronaryBypasssubcategories
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Cardiovascular
33990
arterialaccessonly
33991
arterialandvenousaccessandtransseptalpuncture
33992
Removalduringaseparatesession
Removalduringthesamesessionasinsertionincluded
33993
repositioning duringaseparatesession
Repositioningduringthesamesessionasinsertionisincluded

63

Cardiovascular
Documentationfor3399033993
Includeconscioussedation
Typeofaccess
arterialorarterialandvenous,whichrequires
transseptalpuncture
Removaliscodedifperformedataseparate
session
Repositioningiscodedifperformedataseparate
session

64

102 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Cardiovascular
Conscioussedationnowincluded:
36010Introductionofcatheter,superioror
inferiorvenacava
36140Introductionofneedleorintracatheter;
extremityartery

65

Cardiovascular
Newcodes3622136225describeselectiveandnonselective
arterialcatheterplacementandangiographyintheaortic
arch,andcarotidandvertebralarteries
Included:
vesselaccess
placementofcatheter(s)
contrastinjection(s)
fluoroscopy
radiologicalsupervisionandinterpretation
closureofthearteriotomy
Newguidelinesprovideinstructionforproperuse

66

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Cardiovascular
3622136225,cont
Codesareunilateral
Modifier50isforbilateralservice
CPTprovidesspecificinstructiononappending
modifier59fortheseservices
Codesarebuiltonahierarchyofservices
Whenmorethanoneprocedureisperformedonthe
ipsilateral(sameside)vessel,reportonlythemostcomplex
procedure

67

Cardiovascular
3622136225,cont
Radiologicalsupervisionandinterpretationis
included;however
ifa3Drenderingisperformed,youmayseparatelyreport
76376or76377
ifultrasoundguidanceisrequiredtoaccessthevessel,
report76937
75774maybereportediftheangiographyisnot
performedfortheextracranialandintracranial
cervicocerebralvessels(eg,upperextremities)
Conscioussedationisincluded
68

104 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Cardiovascular
36221
Nonselectivethoracicaortacatheterplacement
Includesangiographyofthecervicocerebralarch
Donotreportwith3622236226
36222
Selectivecatheterplacementincommoncarotidorinnominateartery
includesangiographyofipsilateralextracranialcarotidcirculation
36223
Selectivecatheterplacementincommoncarotidorinnominateartery
Includesangiographyofipsilateral(sameside)intracranialcarotid
circulation,extracranialcarotidandcervicocerebralarch

69

Cardiovascular
36224
Selectivecatheterplacementininternalcarotidartery
Includesangiographyofipsilateralintracranialcarotidcirculation,
extracranialcarotidandcervicocerebralarch
36225
Selectivecatheterplacementinthesubclavianartery
Includesangiographyofipsilateralvertebralcirculationand
cervicocerebralarch
36226
Selectivecatheterplacementinthevertebralartery
Includesangiographyofipsilateralvertebralcirculationand
cervicocerebralarch

70

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Cardiovascular
+36227
Reportinadditionto36222,36223,or36224for
selectivecatheterplacementintheexternal
carotidartery
+36228
Reportinaddition36224or36226forselective
catheterplacementineachintracranialbranchof
theinternalcarotidorvertebralarteries
Donotreport36228morethantwice,perside

71

Cardiovascular
Venipuncturecodedescriptorsarerevisedto
allowreportingbyotherqualifiedhealthcare
professional
36400
36405
36406
36410

72

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Updates

Cardiovascular
37197Transcatheterretrieval,percutaneous,of
intravascularforeignbody(eg,fracturedvenousor
arterialcatheter),includesradiologicalsupervision
andinterpretation,andimagingguidance
(ultrasoundorfluoroscopy),whenperformed
BundlesradiologicalS&Itopercutaneoustranscatheter
retrievalofaforeignbody
37203deleted
Reportretrievalofthevenacavafilterwith37193

73

Cardiovascular
Newcodes3721137214bundleinfusion
thrombolysiswithradiologicalS&Iwhen
performedinarterialandvenousvessels
37201deleted
75896revised
37203deleted
75900deleted
Duringtheprocedures,chemicalsareinfused
tobreakdownclots
74

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Cardiovascular
3721137214,cont
Codesareselectedperday
Ifthetreatmentextendsovermorethanonedateofservice,youmay
useseparatecodestoreportthesubsequenttreatmentdayandthe
cessationorlasttreatmentday
37211
Forinfusionthrombolysisofarteryotherthancoronary
Onceperdayfortheinitialservice
37212
Forinfusionthrombolysisofavein
Onceperdayfortheinitialservice

75

Cardiovascular
3721137214,cont
37213
Infusionthrombolysisofanartery(otherthancoronary)or
vein
Subsequent dayoftherapy
37214
Cessationofinfusionthrombolysisofanartery(otherthan
coronary
Includesremovalofthecatheterandclosureofthevessel

76

108 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Presentation
Updates

HemicandLymphaticSystems
Codesforhematopoieticprogenitorcell(HPC)
transplantation(38240,38241)havebeen
revisedtoassistwithcodeselection
Allogenictransplantation=therecipientisnotthe
donor
Becausetheprocedurecaninvolvecellsfrommore
thanonedonor,theprocedureisreportedperdonor
Includesthephysicianmonitoringphysiological
parameters,verificationofcellprocessing,patient
evaluationanddirectsupervisionoftheinfusion

77

HemicandLymphaticSystems
Autologoustransplantation=therecipientisthe
donor
Includesthephysicianmonitoringphysiological
parameters,verificationofcellprocessing,patient
evaluationanddirectsupervisionoftheinfusion

78

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HemicandLymphaticSystems
Codesforhematopoieticprogenitorcell(HPC)
transplantation(38240,38241)havebeen
revisedtoassistwithcodeselection
Allogenictransplantation=therecipientisnotthe
donor
Becausetheprocedurecaninvolvecellsfrommore
thanonedonor,theprocedureisreportedperdonor
Includesthephysicianmonitoringphysiological
parameters,verificationofcellprocessing,patient
evaluationanddirectsupervisionoftheinfusion

77

HemicandLymphaticSystems
Autologoustransplantation=therecipientisthe
donor
Includesthephysicianmonitoringphysiological
parameters,verificationofcellprocessing,patient
evaluationanddirectsupervisionoftheinfusion

78

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HemicandLymphaticSystems
38243Hematopoieticprogenitorcell(HPC)boost
Mayoccurdays,monthsoryearsfromtheoriginalHPC
transplantation
ComesfromtheoriginalHPCdonorfromtheinitial
transplantation
Totreatarelapseorposttransplantcytopenia(deficiency
orlackofcellularelementsinthecirculatingblood)
38242
Nolongerachildof38240
Forpatientswithpreviousbonemarrowtransplant

79

DigestiveSystem
43206Esophagoscopy,rigidorflexible;with
opticalendomicroscopy
43252Uppergastrointestinalendoscopyincluding
esophagus,stomach,andeithertheduodenum
and/orjejunumasappropriate;withoptical
endomicroscopy
Eliminatesrandomsamplingandallowstargetedbiopsy
throughrealtimecellularobservationofmucosaltissue
Performedforsuspectedpreneoplasticdiseases
Includesmoderatesedation

80

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DigestiveSystem
43234Uppergastrointestinalendoscopy,
simpleprimaryexamination(eg,withsmall
diameterflexibleendoscope)(separate
procedure)
Deleted/rarelyperformed
MostcommonGIendoscopeis43235

81

DigestiveSystem
44705Preparationoffecalmicrobiotafor
instillation,includingassessmentofdonorspecimen
forClostridiumdifficileinstillation
Bacteriumcangrowoutofcontrolfromuseofantibiotics
Includescollectingfecalmaterialfromadonor,preparing
thefecalmaterialinaslurryandevaluatingthematerial
priortoinstillation
Includesonlythepreparationpriortoinstillation,not the
worktoinstillthefecalmicrobiota
Reportinstillationthroughcolonoscopyorsigmoidoscopy
separately

82

112 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

UrinarySystem
52287Cystourethroscopy,withinjection(s)
forchemodenervationofthebladder

Forchemodenervationofthebladder
eg,neurogenicincontinence

83

MaternityCareandDelivery:Repair
59300Episiotomyorvaginalrepair,by
otherthanattendingphysician

Revisedtoallowreportingbyattendingprovider
otherthanphysician
Midwife

84

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NervousSystem
62370Electronicanalysisofprogrammable,
implantedpumpforintrathecalorepiduraldrug
infusion(requiringskillphysicians ofaphysicianor
otherqualifiedhealthcareprofessional)
Nolongerlimitedtophysicianreporting
64561Percutaneousimplantationof
neurostimulatorelectrodearray;sacralnerve
(transforaminalplacement)includingimage
guidance,ifperformed
Nowincludesimagingguidance

85

NervousSystem
64612
Revisedtoaddunilateral
Ifperformedbilaterally,appendmodifier50
64614
Revisedtospecifyextremity(singular)
Reportoncepersessionforextremityand/or
trunkmuscles
Donotreportwithmodifier50

86

114 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

NervousSystem
64615
Describesbilateralchemodenervationofmuscles
innervatedbyfacial,trigeminal,cervicalspineand
accessorynerves
Inherentlybilateral
Donotappendmodifier50
Donotreportwith64612,64613or64614

87

EyeandOcularAdnexa
65800Paracentesisofanteriorchamberofeye
(separateprocedure);withdiagnosticaspiration
removal ofaqueous
65805Paracentesisofanteriorchamberofeye
(separateprocedure);withtherapeuticreleaseof
aqueous
65805deleted
65800nowreporteither diagnosticor therapeuticremoval
ofaqueous

88

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EyeandOcularAdnexa
67810Biopsy Incisionalbiopsy ofeyelid
skinincludinglidmargin
Biopsymustbeofthelidmargin
Report11100,11101or1131011313forbiopsy
oftheskinoftheeyelid

89

Radiology
71040Bronchography,unilateral,radiological
supervisionandinterpretation
71060Bronchography,bilateral,radiological
supervisionandinterpretation
Bronchographyisnolongerperformed
Computedtomography(CT)isnowthestandard
ofcarereplacingbronchography

90

116 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Updates

Radiology
Codesforradiologyexaminationofthe
cervicalspinehavebeenrevisedtoincludethe
numberofviews

72040Radiologicexamination,spine,
cervical;3viewsorless
720504or5views
720526ormoreviews

91

Radiology
Angiographycodes7565075685have
beendeleted
Replacedbycombinationcodesthat
bundlesurgicalandradiologicalservices
See3622136227

92

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Radiology
75896Transcathetertherapy,infusion,anymethod(eg,
thrombolysisotherthanforthrombolysis,radiological
supervisionandinterpretation
75898Angiographythroughexistingcatheterforfollowup
studyfortranscathetertherapy,embolizationorinfusion,
otherthanforthrombolysis
75900Exchangeofapreviouslyplacedintravascularcatheter
duringthrombolytictherapywithcontrastmonitoring,
radiologicalsupervisionandinterpretation
Newcodesinfusionthrombolysiscodes3721137214
includeradiologicalsupervisionandinterpretation

93

Radiology
75961Transcatheterretrieval,percutaneous,
ofintravascularforeignbody(eg,fractured
venousorarterialcatheter),radiological
supervisionandinterpretation
Replacedby37197

94

118 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
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Presentation
Updates

Radiology
Revisedtoincludeotherqualifiedhealthcare
professional

76000/76001Fluoroscopy
76885/76886Ultrasound
+77051/+77052Computeraidedmammography
77071Jointradiography

95

Radiology
763763Drenderingwithimagepostprocessing
underconcurrentsupervision;notrequiringimage
postprocessingonanindependentworkstation
763773Drenderingwithimagepostprocessing
underconcurrentsupervision;requiringimage
postprocessingonanindependentworkstation
Revisedtoincludeimagepostprocessingunderconcurrent
supervision
Parentheticalnotelistsproceduresnotreportedwith
76376/76377

96

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Radiology
Newcodes7801278014replace7800078011
forthyroidimaging
78012toevaluatethefunctionofthegland
78013todeterminethesize,shapeandposition
ofthethyroidgland
78014whentheservicesidentifiedin78012and
78013areperformedduringthesamesession

97

Radiology
78070Parathyroidplanar imaging(including
subtraction,whenperformed)
78071Parathyroidplanarimaging(including
subtraction,whenperformed);withtomographic
(SPECT)
78072Parathyroidplanarimaging(including
subtraction,whenperformed);withtomographic
(SPECT),andconcurrentlyacquiredcomputed
tomography(CT)foranatomicallocalization

98

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PathologyandLaboratory
MolecularPathology
13NewTier1molecularpathologyprocedure
codes
Anunlistedmolecularpathologyprocedure
codeadded(81479)
RevisedthedescriptorsforallnineTier2
(8140081408)procedures

99

PathologyandLaboratory
MultianalyteAssayswithAlgorithmicAnalysis
(MAAA)
Newsubsectionwithguidelinesforproperuse
9newcodes(8150081599)
Algorithmicanalysisusingtheresultsofassays
(molecularpathologyassays,fluorescentinsitu
hybridizationassays,andnonnucleicacidbased
assays)andpatientinformation,when
appropriate,toreportanumericscore(s)or
probabilityofdevelopingspecificconditions

100

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PathologyandLaboratory

MultianalyteAssayswithAlgorithmicAnalysis
(MAAA)
Example:
81503Oncology(ovarian),biochemical
assaysoffiveproteins(CA125,
apoliproproteinA1,beta2microglobulin,
transferrin,andprealbumin),utilizingserum,
algorithmreportedasariskscore

101

PathologyandLaboratory
Chemistry
82009Acetoneorotherketonebodies
Ketonebody(s)(eg,acetone,acetoaceticacid,
serum betahydroxybutyrate);qualitative
82010Acetoneorotherketonebodies Ketone
body(s)(eg,acetone,acetoaceticacid, serum beta
hydroxybutyrate);quantitative

Changesmadetoreflectcurrentclinicalpractice
102

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PathologyandLaboratory
Chemistry
82777Galectin3

Usedtoassesstheprognosisofpatientwith
heartfailure

103

PathologyandLaboratory
Chemistry
8389083914havebeendeleted
Refertomolecularpathologycodes8120081479

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PathologyandLaboratory
Immunology
# 86152Cellenumerationusingimmunologic
selectionandidentificationinfluidspecimen
(eg,circulatingtumorcellsinblood);

# 86153Cellenumerationusingimmunologic
selectionandidentificationinfluidspecimen
(eg,circulatingtumorcellsinblood);physician
interpretationandreport,whenrequired
105

PathologyandLaboratory
Immunology
86711Antibody;JC(JohnCunningham)virus

106

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PathologyandLaboratory
TissueTyping
Newcodes8682886835werecreatedto
reporttissuetypingforsolidorganandbone
marrowtransplants

107

PathologyandLaboratory
Microbiology
87498Infectiousagentdetectionbynucleicacid
(DNAorRNA);enterovirus,reversetranscriptionand
amplifiedprobetechnique
87521Infectiousagentdetectionbynucleicacid
(DNAorRNA);hepatitisC,reversetranscriptionand
amplifiedprobetechnique
87522HepatitisC,reversetranscriptionand
quantification

108

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PathologyandLaboratory
Microbiology
87535Infectiousagentdetectionbynucleicacid
(DNAorRNA);HIV1,reversetranscriptionand
amplifiedprobetechnique
87536HIV1,reversetranscriptionand
quantification
87538HIV2,reversetranscriptionand amplified
probetechnique
87539HIV2,reversetranscriptionand
quantification

109

PathologyandLaboratory
Newcodes8763187633describenucleicacid
testsperformedtodetectrespiratoryviruses
Codesareselectedbasedonthenumberof
targetsforthetest
Parenthetical
Forassaysthatareusedtotypeandsubtype
influenzavirusesonly,see8750187503
Forassaysthatincludeinfluenzaviruseswith
additionalrespiratoryviruses,see8763187633

110

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PathologyandLaboratory
Microbiology
87910Infectiousagentgenotypeanalysis
bynucleicacid(DNAorRNA);
cytomegalovirus
87901Infectiousagentgenotypeanalysis
bynucleicacid(DNAorRNA);HIV1,reverse
transcriptaseandproteaseregions
87912Infectiousagentgenotypeanalysis
bynucleicacid(DNAorRNA);hepatitisBvirus
111

PathologyandLaboratory
SurgicalPathology
88375Opticalendomicroscopicimage(s),
interpretationandreport,realtimeor
referred,eachendoscopicsession
Usedtoreportinterpretationandreportwhen43206
or43252areperformed
Notreportedbythesurgeon,onlywhenperformed
byanotherphysician(eg,pathologist)

112

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PathologyandLaboratory
Codes8838488386havebeendeleted
Seemolecularpathologycodes8120081479

113

Medicine
Manycodesrevisedtoincludeotherqualified
healthcareprofessional,ortoremove
physicianfromthecodedescription
Hemodialysis(90935,90945,90947)
EndStageRenalDiseaseServices(9095190962)
Gastroenterology(91110,91111)
EvaluativeandTherapeuticServices(92613,92615,
92617)

114

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Medicine
Otherqualifiedproviders,cont
Cardiography(93015,93016)
CardiovascularMonitoringServices(93224,
93227,93228,93229,93268,93272)
ImplantableandWearableCardiacDevice
Evaluations(9327993298)
Echocardiography(93351)

115

Medicine
Otherqualifiedproviders,cont
NoninvasivePhysiologicStudiesand
Procedures(93745,93750,93790)
OtherProcedures(93797,93798)
PulmonaryDiagnosticTestingandTherapies
(94014,94016,94452,94453,94610,94774)
AllergyTesting(95004,95024,95027)
AllergenImmunotherapy(9512095134)

116

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Medicine
Otherqualifiedproviders,cont
SpecialEEGTests(95954,95961,95962)
OtherProcedures(95991)
MotionAnalysis(96004)
FunctionalBrainMapping(96020)
TherapeuticProcedures(9753097537)
TestsandMeasurements(97755)
OnlineMedicalEvaluation(98969)
117

Medicine
Otherqualifiedproviders,cont
SpecialServices,ProceduresandReports
(9900099002,99070,+99071,99078,99091)
Moderate(Conscious)Sedation(99143
99150)
OtherServicesandProcedures(99174,99183)

118

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Medicine
Psychiatry:Significantchangestocodesand
guidelines
Newcodes
Interactivecomplexity
Psychiatricdiagnosticevaluation
Psychotherapy
Psychotherapyforcrisis
Pharmacologicmanagement

119

Medicine
InteractiveComplexity
Addoncode(90785)usedtoreport
communicationfactorsthatcomplicatepsychiatric
services
Typicalfactors
Thirdpartiesinvolvedwithcare(guardians,caregivers)
Requireotherstobeinvolvedwiththecare
(interpreters)
Requirethirdparties(welfareagencies,schools)

120

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Medicine
InteractiveComplexitycont
Mustincludeoneofthefollowing:
Managemaladaptivecommunication(highreactivity)
Caregiveremotionsorbehaviorinterferes
Disclosureofsentineleventsandmandatedreporting
(abusetostateagency)
Useofplayequipmentorphysicaldevices
Requireotherstobeinvolvedwiththecare
(interpreters)
Hasnotdevelopedorlostexpressivelanguage
communicationskills.
121

Medicine
InteractiveComplexitycont
Canbeusedwiththefollowingcodes:
Diagnosticpsychiatricevaluation(90791,90792)
Psychotherapy(90832,90834,90837)
PsychotherapywithE/M(90833,90836,90838,99201
99255,9930499337,9934199350)
Grouppsychotherapy(90853)

122

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Medicine
InteractiveComplexity,cont
Donotreportwith:
Psychotherapyforcrisis(90839,90840)
E/Mperformedwithoutpsychotherapy

123

Medicine
PsychiatricDiagnosticEvaluation(90791,90792)
90801,90802deleted
Biophysicalassessmentincludinghistory,mental
statusandrecommendations
DonotreportonthesamedateasE/M
IfmedicalserviceisperformedonsameDOSas
psychiatricdiagnosticevaluation,report90792
Forinteractivecomplexity,report90785with90791
or90792
Donotreport90791and90792onthesameDOS

124

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Medicine
Psychotherapy(9083290838)
9080490809,9081090815,9081690822and9082390829
deleted
Newcodesarebasedontime
Addoncodesusedwhenpsychotherapyisperformedonthe
sameDOSasE/M
DonotincludetimeperformingtheE/Mserviceas
psychotherapytime
Forinteractivepsychotherapy,report90785withthe
psychotherapycode

125

Time Psycho Psychand Psychand Psych,Interactive

(min) therapy E/M Interactive PsychandE/M
Psych

1637 90832 E/M,90833 90832,90785 E/M,90833,

90785

3852 90834 E/M,90836 90834,90785 E/M,90836,

90785
53> 90837 E/M,90838 90837.90785 E/M,90838,
90785

126

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Medicine
PsychotherapyinCrisis(90839,90840)
Urgentassessmentofapatientwithalife
threateningorcomplexcondition
Reportedbasedontime
Ifperformed30minutesorless,reportwith90832or
90833
Donotreportwithpsychiatricdiagnosticevaluation
(90791,90792),psychotherapycodes(9083290838)
orotherpsychiatricservices(9078590899)

127

Medicine
Pharmacologicmanagement(90863)
90862wasdeleted
Newcodeisanaddoncodethatcanonlybe
reportedwithpsychotherapycodes
Donotusetimespentperformingpharmacologic
managementtodeterminepsychotherapycodes
IftheproviderispermittedtobillwithE/Mcodes
(eg,psychiatrist),reporttheserviceasanE/M
Donotreport90863withanE/Mcode

128

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Medicine
Gastroenterology
0242Twasdeletedandreplacedwith91112

91112Gastrointestinaltransitandpressure
measurement,stomachthroughcolon,
wirelesscapsule,withinterpretationand
report

129

Medicine
Ophthalmoscopy
92286Specialanterior Anterior segment
photography imaging withinterpretationandreport;
withspecularendothelial microscopyand
endothelial cellcount analysis
92287Specialanterior Anterior segment
photography imaging withinterpretationandreport;
withfluoresceinangiography

130

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Medicine
CoronaryTherapeuticServicesandProcedures
Codes92980,92981,92982,92984,92995,92996
weredeleted
Servicesinthissubsectioninclude:atherectomy,stent
andangioplastyoncoronaryarteries
Servicesinclude:access,selectivecatheterization,
radiologicsupervisionandinterpretation,closureof
arteriotomy,andimagingtodocumentcompletionof
theprocedure

131

Medicine
CoronaryTherapeuticServicesandProcedures,cont
Coronaryarteries:leftmain,leftanteriordescending,
leftcircumflex,rightmainandramusintermedius
Coronarybranches:diagonalsoftheleftanterior
descending,marginalsofleftcircumflexand
posteriordescendingposterolateralsoftheright

132

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Medicine
Documentationmustinclude:
Majorcoronaryarteriesandbranchesinvolvedinthe
procedure(s)
Proceduresbeingperformed
Morethanoneinterventioncanbeperformedon
multiplevessels
Patientscondition:acutemyocardialinfarctionorchronic
totalocclusion
Therearespecificcodesforthis
Istheprocedurebeingperformedonabypassgraft?

133

Medicine
PCIcodeselection:
Reportonebasecodeforthemostcomplex
procedureforeachmajorcoronaryartery
involvedinthecase
Atherectomy>stent>angioplasty
Canreportuptotwobranches
Conscioussedationincluded

134

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Medicine
92920Percutaneoustransluminalcoronary
angioplasty;singlemajorcoronaryarteryor
branch
+92921Percutaneoustransluminalcoronary
angioplasty;eachadditionalbranchofamajor
coronaryartery(listseparatelyinadditionto
codeforprimaryprocedure)

135

Medicine
92924Percutaneoustransluminalcoronary
atherectomy,withcoronaryangioplastywhen
performed;singlemajorcoronaryarteryor
branch
+92925Percutaneoustransluminalcoronary
atherectomy,withcoronaryangioplastywhen
performed;eachadditionalbranchofamajor
coronaryartery (listseparatelyinadditionto
codeforprimaryprocedure)
136

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Medicine
92928Percutaneoustranscatheterplacementof
intracoronarystent(s),withcoronaryangioplasty
whenperformed;singlemajorcoronaryarteryor
branch
+92929Percutaneoustranscatheterplacementof
intracoronarystent(s),withcoronaryangioplasty
whenperformed;eachadditionalbranchofamajor
coronaryartery(listseparatelyinadditiontocodefor
primaryprocedure)

137

Medicine
92933Percutaneoustransluminalcoronary
atherectomy,withintracoronarystent,withcoronary
angioplastywhenperformed;singlemajorcoronary
arteryorbranch
+92934Percutaneoustransluminalcoronary
atherectomy,withintracoronarystent,withcoronary
angioplastywhenperformed;eachadditionalbranch
ofamajorcoronaryartery (listseparatelyinaddition
tocodeforprimaryprocedure)

138

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Medicine
92937Percutaneoustransluminalrevascularization
oforthroughcoronaryarterybypassgraft(internal
mammary,freearterial,venous),anycombinationof
intracoronarystent,atherectomyandangioplasty,
includingdistalprotectionwhenperformed;single
vessel
92938eachadditionalbranchsubtendedbythe
bypassgraft(listseparatelyinadditiontocodefor
primaryprocedure)

139

Medicine
92941Percutaneoustransluminal
revascularizationofacutetotal/subtotal
occlusionduringacutemyocardialinfarction,
coronaryarteryorcoronaryarterybypass
graft,anycombinationofintracoronarystent,
atherectomyandangioplasty,including
aspirationthrombectomywhenperformed,
singlevessel

140

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Medicine
92943Percutaneoustransluminalrevascularization
ofchronictotalocclusion,coronaryartery,coronary
arterybranch,orcoronaryarterybypassgraft,any
combinationofintracoronarystent,atherectomyand
angioplasty;singlevessel
+92944eachadditionalcoronaryartery,coronary
arterybranch,orbypassgraft(listseparatelyin
additiontocodeforprimaryprocedure)

141

Medicine
PCIexample:Stentplacedandangioplasty
performedonLAD,stentplacedinD1,
angioplastyinD2

142

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Medicine
Correct Codes:
92928-LD,
92929-LD,
92921-LD

Picture Source: Radiology Assistant

http://www.radiologyassistant.nl/en/p48275120e2ed5

143

Medicine
+92973Percutaneoustransluminalcoronary
thrombectomymechanical (listseparatelyin
additiontocodeforprimaryprocedure)

Coderevisedbecausethiscodeisnotusedfor
chemicalthrombectomyonlymechanical

144

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Medicine
IntracardiacElectrophysiologicalProcedures
93651and93562havebeendeleted
Newcodes9365393657reportedfor
comprehensiveelectrophysciologicevaluation
andablationofarrhythmia
Codeisselectedbasedonthearrhythmiatreated

145

Medicine
AllergyTesting
Codes95010and95015weredeleted
Reportwith95017or95018basedon
whethervenomordrugsandbiologicalsare
usedinthetesting

146

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Medicine
Code95075hasbeendeletedandreplacedwithtime
basedcodes95076and95079

95076Ingestionchallengetest(sequentialand
incrementalingestionoftestitems,eg,food,drugor
othersubstance);initial120minutesoftesting
+95079eachadditional60minutesoftesting(list
separatelyinadditiontocodeforprimaryprocedure)

147

Medicine
SleepMedicineTesting
Codesrevisedtoincludetheageofthepatient
95808reportedforanyage
95810,95811forages6yearsandolder
Newcodes95782,95783forpatientsyounger
than6years

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Medicine
NerveConductionStudies
Codes9500095004weredeleted
Newcodes9590795913reportedbasedonthe
numberofstudiesperformed
Motornerveconductionstudies:electrodesplaced
overthemotorpointsofthemusclebeingtested
Nerveconductionstudies:electrodesplacedoverthe
specificnervetobetested

149

Medicine
NerveConductionStudies,cont
Astudyisdefinedassensoryconductiontest,
amotorconductiontestwithorwithoutanF
wavetest,oranHreflextest
UseAppendixJtoassistwithcoding

150

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Medicine
IntraoperativeNeurophysiology
95920isdeleted
Codesreportedbasedonwhetherthemonitoringis
oneononeintheoperatingroom(95940)orremote
(95941)
Reportaddonswiththebaselinestudies
Ifmorethanonepatientismonitoredinthe
operatingroom,report95941
Cannotbereportedbythesurgeonor
anesthesiologist

151

CategoryII
Supplementalcodesfortrackingperformance
measures
MoreinformationontheAMAsite
www.amaassn.org/ama/pub/physicianresources/solutionsmanaging
yourpractice/codingbillinginsurance/cpt/aboutcpt/categoryii
codes.page

MoreinformationontheCMSsite
http://www.cms.gov/Medicare/QualityInitiativesPatientAssessment
Instruments/PQRS/MeasuresCodes.html

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CategoryIII
DeletedCat.Code ReplacementCode
0030T 86849
0048T 33991
0050T 3399033993
0173T N/A
0242T 91112
0250T0252T 3164731649

153

CategoryIIICodes
DeletedCat.IIICode ReplacementCode
0256T 3336133364
0257T 33365+0318T
0258T 33365+33366
0259T 3336533369
0276T,0277T 31660,31661
0279T,0280T 86152,86153

154

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CategoryIIICodes
0195TArthrodesis,presacral
interbodytechniquewithout
instrumentationL5S1interspace
+0196TL4L5interspace
Codesrevisedtoindicatewithout
instrumentation
Distinguishfrom22586(with
instrumentation)
155

CategoryIIICodes
0206TAlgorithmic Computerizeddatabase
analysisofmultiplecyclesofdigitizedcardiac
electricaldatafromtwoormoreECGleads,including
transmissiontoa remotecenter,application of
electrocardiographicderiveddata multiplenonlinear
mathematicaltransformations, withcomputer
probabilityassessment,includingreport coronary
arteryobstructionseverityassessment
Revisedtodescribecoronaryarteryobstruction
Not intendedforcardiacischemia

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CategoryIIICodes
+0291Tintravascularopticalcoherence
tomographyinitialvessel(listseparatelyin
additiontoprimaryprocedure)
Providesmicrostructuralinformationon
atheroscleroticplaques
Reportwith92920,92924,92928,92933,92937,
92941,92943,92975,9345493461,93563,93564
fortheinitialvessel
Includesconscioussedation

157

CategoryIIICodes
+0292TIntravascularopticalcoherence
tomographyeachadditionalvessel(list
separatelyinadditiontoprimaryprocedure)
Addonwith0291T
Reportwith92920,92924,92928,92933,92937,
92941,92943,92975,9345493461,93563,93564
fortheinitialvessel
Includesconscioussedation

158

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CategoryIIICodes
0293TInsertionofleftatrialhemodynamic
monitor;completesystem,includesimplanted
communicationmoduleandpressuresensorlead
inleftatriumincludingtransseptalaccess,
radiologicalsupervisionandinterpretation,and
associatedinjectionprocedures,whenperformed
Insertiontomonitorleftatrialpressure
Donotreportwith93462or93662
Includesconscioussedation

159

CategoryIIICodes
+0294TInsertionofleftatrialhemodynamic
monitor;pressuresensorleadattimeofinsertionof
pacingcardioverterdefibrillatorpulsegenerator
includingradiologicalsupervisionandinterpretation
andassociatedinjectionprocedures
Devicetomonitorleftatrialpressureduringinsertionofa
pacingcardioverterdefibrillator
Claimwith33230,33231,33240,3326233264or33249
Donotreportwith93462or93662
Includesconscioussedation

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CategoryIIICodes
Newcodesdescribeexternalelectrocardiographic
recordingformorethan48hours,upto21days.
Currentcodes(9322492337)reportsimilarrecording
whenperformedupto48hours.
0295Trecording,scanninganalysiswithreport,
reviewandinterpretation
0296Trecording(includesconnectionandinitial
recording)
0297Tscanninganalysiswithreport
0298Treviewandinterpretation
161

CategoryIIICodes
0299TExtracorporealshockwavefor
integumentarywoundhealing,highenergy,
includingtopicalapplicationanddressing
care;initialwound
+0300Teachadditionalwound(list
separatelyinadditiontocodeforprimary
procedure)
Promoteshealingofburnwounds
Reportperwound

162

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CategoryIIICodes
0301TDestruction/reductionofmalignantbreast
tumorwithexternallyappliedfocusedmicrowave,
includinginterstitialplacementofdisposable
catheterwithcombinedtemperaturemonitoring
probeandmicrowavefocusingsensocatheterunder
ultrasoundthermotherapyguidance
Focusedmicrowavethermotherapyofthebreast
Includesimagingguidance
Includesconscioussedation
Donotreportwith76645,76942,76998or7760077615

163

CategoryIIICodes
Intracardiacischemicmonitoringsystemdetects/warns
patientsofmajorischemiccoronaryevent
eg,coronaryplaquerupture
Includesagenerator,adaptorandtransvenouslead
0302TInsertionorremovalandreplacementof
intracardiacischemiamonitoringsystemincludingimaging
supervisionandinterpretationwhenperformedandintra
operativeinterrogationandprogrammingwhenperformed;
completesystem(includesdeviceandelectrode)
Includesconscioussedation
Insertorremovecompletesystem

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2013 Procedure Coding Updates

CategoryIIICodes
Intracardiacischemicmonitoring,cont
0303TInsertionorremovalandreplacement
electrodeonly
Electrodeonlyinsertion/replacement
Includesinterrogationandprogramming
Includesconscioussedation
0304Tdeviceonly
Deviceonlyinsertion/replacement
Includesinterrogationandprogramming
Includesconscioussedation

165

CategoryIIICodes
Intracardiacischemicmonitoring,cont
0305TProgrammingdeviceevaluation(inperson)of
intracardiacischemiamonitoringsystemwithiterative
adjustmentofprogrammedvalues,withanalysis,review,and
report
Programmingandadjustments
Mustbeperformedinperson
0306TInterrogationdeviceevaluation(inperson)of
intracardiacischemiamonitoringsystemwithanalysis,review,
andreport
Systeminterogation,includinganalysis,reviewandreport
Mustbeperformedinperson

166

154 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure
Slide
Coding
Presentation
Updates

CategoryIIICodes
Intracardiacischemicmonitoring,cont
0307TRemovalofintracardiacischemia
monitoringdevice
Deviceremovalwithoutreplacement
Includesconscioussedation

167

CategoryIIICodes
0308TInsertionofoculartelescope
prosthesisincludingremovalofcrystallinelens
Insertion/implantationofatelescope
Forpatientswithcentralvisionlosscausedby
endstage,agerelatedmaculardegeneration
Modifier51exempt
Includesconscioussedation

168

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 155

Complete
Slide Presentation
2013 Procedure Coding Updates

CategoryIIICodes
+0309TArthrodesis,presacralinterbody
technique,includingdiscspacepreparation,
discectomy,withposteriorinstrumentation,with
imageguidance,includesbonegraft,when
performed,lumbar,L4L5interspace(listseparately
inadditiontocodeforprimaryprocedure)
Presacralinterbodytechniquearthrodesiswith posterior
instrumentation
Includesdiscpreparation,discectomy,posterior
instrumentation,imagingguidanceandbonegraft
PerformedatL4L5interspace

169

CategoryIIICodes
0310TMotorfunctionmappingusingnon
invasivenavigatedtranscranialmagnetic
stimulation(nTMS)fortherapeutictreatment
planning,upperandlowerextremity
Motorfunctionmappingcombiningtranscranial
magneticstimulation(TMS)andelectromyography
(EMG)withguidance,withmagneticresonance
Performedtoidentifyfunctionalmotorcortex
priortobrainsurgery

170

156 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
 Complete 2013 Procedure
Slide
Coding
Presentation
Updates

CategoryIIICodes
0311TNoninvasivecalculationand
analysisofcentralarterialpressurewaveforms
withinterpretationandreport
Centralarterialpressurewaveformsforpatients
withdifficulttotreathypertension

171

CategoryIIICodes
Vagalblockingforweightloss
0312T=laparoscopicimplantationofthe
neurostimulatorelectrodearray,pulsegenerator
andprogramming
0313T=laparoscopicrevisionorreplacementof
theelectrodearray,andconnectiontotheexisting
pulsegenerator
0314T=laparoscopicremovaloftheelectrode
arrayandpulsegeneratoronly

172

= FDA Approval Pending = Add-on Complete 2013 Procedure Updates 157

Complete
Slide Presentation
2013 Procedure Coding Updates

CategoryIIICodes
Vagalblockingforweightloss,cont
0315T=removalofthepulsegeneratoronly
0316T=replacementofthepulsegeneratoronly
0317T=electronicanalysisandreprogramming
ofthepulsegenerator

173

CategoryIIICodes
0318TImplantationofcatheterdelivered
prostheticaorticheartvalve,openthoracic
approach,(eg,transapical,otherthan
transaortic)
Implantationofaprostheticaorticheartvalve
Reportedbasedonapproach
0318T=openthoracicapproach
3336133365forotherapproaches

174

158 = New = Revised Underline = New/Revised Text Strikethrough = Deleted Code/Text # = Resequenced Code = Service/Procedure Includes Moderate Sedation
 The Official
American Medical Association
CPT Errata
 CORRECTIONS DOCUMENTCPT 2013
Introduction

Current Procedural Terminology (CPT), Fourth Edition, is a set of

Inclusion of a descriptor and its associated five-digit code number in

Add new text symbols to denote revision of the text in the Introduction to the CPT
code set.

Evaluation and Management (E/M) Services Guidelines

Counseling
Counseling is a discussion with a patient and/or family concerning one or more of the
following areas:
Diagnostic results, impressions, and/or recommended diagnostic studies
Prognosis
Risks and benefits of management (treatment) options
Instructions for management (treatment) and/or follow-up
Importance of compliance with chosen management (treatment) options
Risk factor reduction
Patient and family education
(For psychotherapy, see 90832-90834, 90836-90840)

Add an instructional parenthetical note following the counseling guidelines to coincide

with the new psychotherapy range of codes 90832-90834 and 90836-90840.

Evaluation and Management Tables

Initial Neonatal Intensive Care

Remove reference to weight 1500-5000 gms from the (E/M) Initial Neonatal Intensive
Care table.

Revised: 10/19/2012 - 9:49:26 AM 1

Copyright 1995-2012 American Medical Association All Rights Reserved
Evaluation and Management Table
Continuing Neonatal and Infant Inpatient
Low Birth-Weight Intensive Care

Remove reference to age 28 days of age or less from the (E/M) Continuing Neonatal and
Infant Inpatient Low Birth-Weight Intensive Care table.

Evaluation and Management

Nursing Facility Services guidelines

The following codes are used

These codes should also be used
Nursing facilities that provide
Physicians and other qualified health care professionals have a central role in assuring that all
residents receive thorough assessments and that medical plans of care are instituted or revised to
enhance or maintain the residents physical and psychosocial functioning. This role includes
providing input in the development of the MDS and a multi-disciplinary plan of care, as required
by regulations pertaining to the care of nursing facility residents.
Two major subcategories of nursing facility services
For definitions of key components...

Revise the Nursing Facility Services guidelines by removing reference to the terms and
other qualified health care professionals as initial assessments in the nursing facility are
only done by physicians.

Revised: 10/19/2012 - 9:49:26 AM 2

Copyright 1995-2012 American Medical Association All Rights Reserved
Evaluation and Management
Hospital Inpatient Services
Subsequent Hospital Care
Hospital Discharge Services
The hospital discharge day
99238 Hospital discharge day management; 30 minutes or less
99239 more than 30 minutes
(These codes are to be utilized by the physician to report all services provided
to a patient on the date of discharge, if other than the initial date of inpatient
status. To report services to a patient who is admitted as an inpatient and
discharged on the same date, see codes 99234-99236 for observation or inpatient
hospital care including the admission and discharge of the patient on the same
date. To report concurrent care services provided by a physician[s] other than the
ordering physician or another qualified health care professional, use subsequent
hospital care codes [99231-99233] on the day of discharge.)

Revise the parenthetical note following code 99239 to remove reference to provider

Surgery
Musculoskeletal System
General
Grafts (or Implants)

20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery

only (List separately in addition to code for primary procedure)

(Use 20930 in conjunction with 22319, 22532, 22533, 22548-22558, 22590-

22612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T)

20936 Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs,
spinous process, or laminar fragments) obtained from same incision (List
separately in addition to code for primary procedure)

(Use 20936 in conjunction with 22319, 22532, 22533, 22548-22558, 22590-

22612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T)

20937 morselized (through separate skin or fascial incision) (List separately in

addition to code for primary procedure)

(Use 20937 in conjunction with 22319, 22532, 22533, 22548-22558, 22590-

22612, 22630, 22633, 22634, 22800-22812, 0195T, 0196T)

Revise the parenthetical notes following 20930, 20936 and 20937 by removing reference to
Category III codes 0195T and 0196T to reflect code revisions that now make these
inappropriate for reporting with these graft services.

Revised: 10/19/2012 - 9:49:26 AM 3

Copyright 1995-2012 American Medical Association All Rights Reserved
Surgery
Respiratory System
Trachea and Bronchi
Endoscopy

For endoscopy procedures, code appropriate endoscopy of each anatomic site examined.
Surgical bronchoscopy always includes diagnostic bronchoscopy when performed by the same
physician. Codes 31622-3164931651, 31660, 31661 include fluoroscopic guidance, when
performed.

(For tracheoscopy, see laryngoscopy codes 31515-31578)

31615 Tracheobronchoscopy through established tracheostomy incision

Revise the Endoscopy introductory guidelines to include the new range of codes 31622-
31651, 31660, 31661 that include fluoroscopic guidance when performed.
Surgery
Respiratory System
Trachea and Bronchi
Endoscopy
31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when
performed; diagnostic, with cell washing, when performed (separate procedure)

31627 with computer-assisted, image-guided navigation (List separately in

addition to code for primary procedure[s])

(31627 includes 3D reconstruction. Do not report 31627 in conjunction with

76376, 76377)

(Use 31627 in conjunction with 31615, 31622-31631, 31622-31626. 31628-

31631, 31635, 31636, 31638-31643)

Revise the second parenthetical note following 31627 by expanding the code range 31622-
31631 to exclude code 31627.
Surgery
Respiratory System
Trachea and Bronchi
Endoscopy

Bronchoscopy (Illustration)
31622-31646 31651
A rigid or flexible bronchoscope is inserted through the oropharynx and vocal cords and
beyond the trachea into the right or left bronchi.

Revise the range of codes included in the bronchoscopy illustration to include the entire
range of bronchoscopy codes.

Revised: 10/19/2012 - 9:49:26 AM 4

Copyright 1995-2012 American Medical Association All Rights Reserved
Surgery
Cardiovascular System
Heart and Pericardium
Patient-Activated Event Recorder

33282 Implantation of patient-activated cardiac event recorder

(Initial implantation includes programming. For subsequent electronic analysis

and/or reprogramming, use 93285, 93291, 93298, 93299)

Add code 93299 to the parenthetical note following 33282.

Surgery
Cardiovascular System
Arteries and Veins
Transcatheter Procedures
Other Procedures

37205 Transcatheter placement of an intravascular stent(s) (except coronary, carotid,

vertebral, iliac, and lower extremity arteries), percutaneous; initial vessel

(For radiological supervision and interpretation, use 75960)

(For transcatheter placement of intravascular cervical carotid artery stent(s), see

37215, 37216)

(For transcatheter placement of intracranial stents, use 61635)

(For transcatherter transcatheter coronary stent placement, see 92980,

92981)

Revise the misspelled word transcatheter noted in the parenthetical note following
37205.
Surgery
Digestive System
Pharynx, Adenoids, and Tonsils
Excision, Destruction

42894 Resection of pharyngeal wall requiring closure with myocutaneous or

fasciocutaneous flap or free muscle, skin, or fascial flap with microvascular
anastamosis anastomosis

Revise the misspelled word anastomosis noted in code 42894.

Revised: 10/19/2012 - 9:49:26 AM 5

Copyright 1995-2012 American Medical Association All Rights Reserved
Pathology and Laboratory
Molecular Pathology
Tier 1 Molecular Pathology Procedures

#81161 DMD (dystrophin) (eg, Duchenne/Becker muscular dystrophy) deletion analysis,

and duplication analysis, if performed

Add code 81161 as an active code for 2013.

Pathology and Laboratory
Molecular Pathology
Tier 1 Molecular Pathology Procedures

81201 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP],
attenuated FAP) gene analysis; full gene sequence

Revise code 81201 by italicizing the gene name APC (adenomatous polyposis coli).
Pathology and Laboratory
Molecular Pathology
Tier 1 Molecular Pathology Procedures

81252 GJB2 (gap junction protein, beta 2, 26kDa;, connexin 26) (eg, nonsyndromic
hearing loss) gene analysis; full gene sequence

Revise code 81252 by adding a comma after 26KDa, and removing the semicolon.
Pathology and Laboratory
Tier 2 Molecular Pathology Procedures

81401 Molecular pathology procedure, Level 2 (eg, 2-10 SNPs, 1 methylated variant, or
1 somatic variant [typically using nonsequencing target variant analysis], or
detection of a dynamic mutation disorder/triplet repeat)

EWSR1/ERG (t(21;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor),

translocation analysis, qualitative, and quantitative, if performed

EWSR1/FLI1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor),

translocation analysis, qualitative, and quantitative, if performed

EWSR1/WT1 (t(11;22)) (eg, Ewing sarcoma/peripheral neuroectodermal tumor),

translocation analysis, qualitative, and quantitative, if performed

Revise 81401 to include the following missing analyte EWSR1/WT1

Revised: 10/19/2012 - 9:49:26 AM 6

Copyright 1995-2012 American Medical Association All Rights Reserved
Pathology and Laboratory
Tier 2 Molecular Pathology Procedures

81402 Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2-10 methylated
variants, or 2-10 somatic variants [typically using non-sequencing target variant
analysis], immunoglobulin and T-cell receptor gene rearrangements,
duplication/deletion variants 1 exon)

TCD@ TRD@ (T cell antigen receptor, delta) (eg, leukemia and lymphoma),
gene rearrangement analysis, evaluation to detect abnormal clonal population

Revise the analyte following 81402 by removing [TCD@] and replacing it with [TRD@].
Pathology and Laboratory
Multianalyte Assays with
Algorithmic Analyses

81503 Oncology (ovarian), biochemical assays of five proteins (CA-125,

apoliproprotein apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-
albumin), utilizing serum, algorithm reported as a risk score

Revise the misspelled word apolipoprotein noted in code 81503.

Pathology and Laboratory
Multianalyte Assays with
Algorithmic Analyses

81506 Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose,

HbA1c, insulin, hs-CRP, adoponectin adiponectin, ferritin, interleukin 2-receptor
alpha), utilizing serum or plasma, algorithm reporting a risk score

Revise the misspelled word adiponectin noted in code 81506.

Pathology and Laboratory
Transfusion Medicine

86890 Autologous blood or component, collection processing and storage; predeposited

86891 intra- or postoperative salvage

(For physician services to autologous donors, see 99201-99204)

Delete the parenthetical note following 86891.

Revised: 10/19/2012 - 9:49:26 AM 7

Copyright 1995-2012 American Medical Association All Rights Reserved
Medicine
Cardiovascular
Cardiography

Codes 93040-93042 are appropriate when an order for the test is triggered by an event, the
rhythm strip is used to help diagnose the presence or absence of an arrhythmia, and a report is
generated. There must be a specific order for an electrocardiogram or rhythm strip followed by a
separate, signed, written, and retrievable report. It is not appropriate to use these codes for
reviewing the telemetry monitor strips taken from a monitoring system. The need for an
electrocardiogram or rhythm strip should be supported by documentation in the patient medical
record.

(For echocardiography, see 93303-93350)

(For electrocardiogram, 64 leads or greater, with graphic presentation and analysis, see 0178T-
0180T use 93799)

93000 Electrocardiogram, routine ECG

Delete reference to code 93799 from the parenthetical note preceding 93000 and replace
with codes 0178T-0180T.

Category III

(0258T has been deleted. To report, see 33365, 33366 0318T)

Revise the instructional parenthetical note for deleted code 0258T by removing code 33366
and adding Category III code 0318T.
Appendix D
Summary of CPT Add-on Codes

95915
95916

Delete reference to codes 95915 and 95916 from Appendix D, as these are not active CPT
codes.
Appendix F
Summary of CPT Codes
Exempt from Modifier 63

99337

Delete reference to code 99337 from Appendix F.

Revised: 10/19/2012 - 9:49:26 AM 8

Copyright 1995-2012 American Medical Association All Rights Reserved
Appendix O
Multianalyte Assays with
Algorithmic Analyses
Proprietary Name and Clinical Laboratory
or Manufacturer
Category I Codes for Multianalyte Assays with Algorithmic Analyses (MAAA)
No proprietary name and clinical
laboratory or manufacturer:
Maternal serum screening procedures are
well established procedures and are
performed by many labs throughout the
country. The concept of prenatal screens
has existed and evolved for over ten years
and is not exclusive to any one facility.
Add multianalyte assay reference codes 81508 and 81599 to the Appendix O table.
Revised: 10/19/2012 - 9:49:26 AM
Copyright 1995-2012 American Medical Association All Rights Reserved
Alpha-Numeric
Code Descriptor
Code
81508 Fetal congenital abnormalities,
biochemical assays of two proteins
(PAPP-A, hCG [any form]), utilizing
maternal serum, algorithm reported as a
risk score
81509 Fetal congenital abnormalities,
biochemical assays of three proteins
(PAPP-A, hCG [any form], DIA),
utilizing maternal serum, algorithm
reported as a risk score
81510 Fetal congenital abnormalities,
biochemical assays of three analytes
(AFP, uE3, hCG [any form]), utilizing
maternal serum, algorithm reported as a
risk score
81511 Fetal congenital abnormalities,
biochemical assays of four analytes
(AFP, uE3, hCG [any form], DIA)
utilizing maternal serum, algorithm
reported as a risk score (may include
additional results from previous
biochemical testing)
81512 Fetal congenital abnormalities,
biochemical assays of five analytes
(AFP, uE3, total hCG, hyperglycosylated
hCG, DIA) utilizing maternal serum,
algorithm reported as a risk score
81599 Unlisted Multianalyte assay with
algorithmic analysis
9
Medium Descriptors
Short Descriptors

95907 MOTOR &/SENS 1-2 NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&/SENS 1-2 NRV CNDJ TST

NERVE CONDUCTION STUDIES 1-2 STUDIES

NVR CNDJ TST 1-2 STUDIES

95908 MOTOR &/SENS 3-4 NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&/SENS 3-4 NRV CNDJ TST

NERVE CONDUCTION STUDIES 3-4 STUDIES

NRV CNDJ TST 3-4 STUDIES

95909 MOTOR &/SENS 5-6 NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&/SENS 5-6 NRV CNDJ TST

NERVE CONDUCTION STUDIES 5-6 STUDIES

NRV CNDJ TST 5-6 STUDIES

95910 MOTOR &/SENS 7-8 NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&SENS 7-8 NRV CNDJ TEST

NERVE CONDUCTION STUDIES 7-8 STUDIES

NRV CNDJ TEST 7-8 STUDIES

95911 MOTOR &/SENS 9-10 NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&SEN 9-10 NRV CNDJ TEST

NERVE CONDUCTION STUDIES 9-10 STUDIES

NRV CNDJ TEST 9-10 STUDIES

95912 MOTOR &/SENS 11-12 NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&SEN 11-12 NRV CND TEST

NERVE CONDUCTION STUDIES 11-12 STUDIES

NRV CNDJ TEST 11-12 STUDIES

95913 MOTOR &/SENS 13/> NRV CNDJ PRECONF ELTRODE LIMB

MOTOR&SENS 13/> NRV CND TEST

NERVE CONDUCTION STUDIES 13/> STUDIES

NRV CNDJ TEST 13/> STUDIES

Revise medium and short descriptor for codes 95907-95913.

Revised: 10/19/2012 - 9:49:26 AM 10

Copyright 1995-2012 American Medical Association All Rights Reserved
Medium Descriptor

27499 DCMPRN FASCT THIGH&/KNEE MLT DBRDMT NV MUSC&AM NRVE

75956 EVASC RPR DESCND THORCIC AORTA SUBCLAV ORIG RS&I
75957 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
75958 EVASC RPR DESCND THORCIC AORTA CELIAC ORIG RS&I
75959 PLMT DSTL XTN PRSTH EVASC DESC THORAC AORTA RS&I
88154 CYTP SLIDES C/V MNL SCR&CPTR-RESCR CELL S&I
88167 CYTP SLIDES C/V MNL SCR&CPTR RESCR CELL S&I
93459 CATH PLMT L HRT/ARTS/GRFTS WNJX & ANGIO IMG S&I

Revise medium descriptor for codes 27499, 75956, 75957, 75958, 75959, 88154, 88167, and
93459.

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Revised: 10/19/2012 - 9:49:26 AM 11

Copyright 1995-2012 American Medical Association All Rights Reserved