As you page through your newly released 2017 CPT manual, the biggest change you’ll notice may be what’s missing: The list of more than 400 codes that were defined as including moderate sedation has been deleted from Appendix G.
Also deleted: the hundreds of little bulls-eye symbols next to codes that once included moderate sedation.
The change was first announced in the proposed 2017 Medicare physician fee schedule as Part B News reported July 8. Now providers who perform moderate sedation with a procedure must report the appropriate new moderate sedation code (99151-99157) to receive full payment. It will not be appropriate to report modifier 52 (Reduced services) with a procedure that is not performed with moderate sedation.
Other changes to note:
Imaging bundled into epidurals. You’ll code for epidurals based on the use of imaging next year (62320-62327). The descriptor for the codes with imaging specifies fluoroscopy or CT, but the guidelines state the codes that include imaging may not be reported with fluoroscopy (77003), CT (77012) or ultrasound (76942).
Another round of drug screen changes. CPT adopted CMS’ current model for its next set of presumptive drug screens, which means providers will have one set of rules to follow for these kinds of tests next year. You’ll report one of three codes (80305-80307) based on the test method used, and it will be reported with one unit of service. CMS has signaled that it will adopt the new codes in its proposed 2017 clinical laboratory fee schedule.
A new telemedicine modifier. Modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) debuts in the 2017 CPT manual to presumably take the place of Medicare’s modifier GT.
Influenza vaccine codes will now be coded by dosage, not age. The descriptions were revised to remove reference to patient age – instead, you’ll code them by dosage. For example, in code 90655, “when administered to children 6-35 months of age” has been removed. Instead, the code now refers to “0.25 mL dosage.” The change affects codes 90655-90661 and 90685-90688.
Overhaul of bunionectomy codes. Changes include deletion of codes 28290, 28293 and 28294 and revisions to codes 28292 and 28296 to remove reference to names and add specifics about what is performed during the procedure. For example, the description of 28292 now states: Correction, hallux valgus (bunionectomy) with sesamoidectomy when performed; with resection of proximal phalanx base when performed, any method. Two new procedure codes also were added.
Wound care code 97602 has been revised to include larval therapy, otherwise known as maggots.