CPT Codes for 2013
There are several Current Procedural Terminology® (CPT) code changes for 2013 applicable to otolaryngologists. Below is a summary of these changes. If you have any questions regarding CPT code changes for 2013, please contact the Health Policy team.
CPT Changes for 2013: What ENTs Need to Know
Part of the annual rulemaking process conducted by the Centers for Medicare and Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Associations (AMA) Current Procedural Terminology (CPT) Editorial Panel, for the coming year. In addition, CMS includes new, or updated, values (also known as relative value units (RVUs)) for medical services which have undergone review by the American Medical Associations Relative Update Committee (AMA RUC). CMS has the discretion to accept the RUCs RVU recommendations for physician work, as well as their recommendations for direct practice expense inputs, or they may exercise their administrative authority and elect to assign a different value, or practice expense inputs, for medical procedures paid for by Medicare. The final value, as determined by CMS, is then publicly released in the final Medicare Physician Fee Schedule (MPFS) rule for the following calendar year.
The Academy is an active participant in both the AMA RUC valuation of otolaryngology-head and neck services, and the CMS annual rulemaking processes. As part of those efforts, we want to ensure members are informed and prepared for key changes to CPT codes and valuations related to otolaryngology-head and neck surgery serviced for CY 2013. The following outlines a list of coding changes, including new and revised CPT codes, as well as codes which were reviewed by the AMA RUC and could have modified Medicare reimbursement values for 2013:
New Codes for 2013
In CY 2013, several new CPT codes will be introduced, including:
- 2 new codes to report pediatric polysomnography for children under the age of 6. These services will be reported using new CPT codes 95782 and 95783.
- 2 new codes to report allergy testing. These codes replace former codes95010 and 95015.
- 2 new codes to report ingestion challenge testing. These codes replace 95075.
- 2 new codes to report intraoperative neurophysiology monitoring in the operating room. This includes new introductory language in that section of the CPT book as well. These services will be reported using new CPT codes 95940 and G0453.
Codes Reviewed by the AMA RUC
Several codes relating to otolaryngology were reviewed by the AMA RUC and their RUC approved values were submitted to CMS for final determination for the CY 2013 final rule. It is critical that members keep in mind that maintaining value for otolaryngology-head and neck surgery services is an enormous success in light of the rigorous review and cost-saving focus of both the AMA RUC and CMS. Therefore, the Academy is pleased that we were able to maintain, or increase, relative value units for nearly all codes reviewed in the 2012 RUC cycle (for specific values access our summary table via the link at the bottom of this page). Services which were in reviewed in CY 2012 include:
- 13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm
- 13150 Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less
- 13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
- 13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm
- 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
- 40490 Biopsy of lip
- 69200 Removal foreign body from external auditory canal; without general anesthesia
- 69433 Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia
New Codes for Pediatric Polysomnogrophy
- 95782 younger than 6 years, sleep staging with 4 or more additional parameters of sleep, attended by a technologist
- 95783 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
New Codes for Allergy Testing and Ingestation Challenge Testing
Allergy Testing: CPT codes 95010 and 95015 have been deleted. To report, use the two new codes below.
- 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
- 95018 Allergy testing, any combination of percutaneous (scratch, puncture, prick) and intracutaneous (intradermal), sequential and incremental, with drugs or biologicals, immediate type reaction, including test interpretation and report, specify number of tests
- Note: These new codes are differentiated based on whether the testing utilizes venoms (95017) or drugs and biologicals (95018), rather than based on the technique that is used which is how the former codes were structured. The change was made because there is little difference in work between percutaneous and intracutaneous testing. The cost of supplies, however, varies greatly and as a result these new codes were created to allow for more specific identification of the effort and materials included as part of the procedures.
Ingestion Challenge Testing: CPT 95075 has been deleted and two new codes have been created to report ingestion challenge testing.
- 95076 Ingestion challenge test (sequential and incremental ingestion of test items, eg, food, drug or other substance); initial 120 minutes of testing
- +95079 each additional 60 minutes of testing (List separately in addition to code for primary procedure)
- Note: These new codes have been created to allow description of this service as a time-based service. 95076 is used to identify the first 120 minutes of allergen ingestion testing using food, drugs, or other substances and 95079 should be used to identify each additional 60 minutes of testing. Any testing less than 61 minutes should be reported using an Evaluation and Management (E/M) code. Patient assessment or monitoring for allergic reaction should NOT be reported separately, however, intervention therapy (eg, injection of steroid or epinephrine) may be reported separately as appropriate
New Add On Codes for Interoperative Neurophysiciology Monitoring
- +95940 Continuous intraoperative neurophysiology monitoring in the operating room, one on one monitoring requiring personal attendance, each 15 minutes (List separately in addition to code for primary procedure)
- G0453 Continuous intraoperative neurophysiology monitoring, from outside the operating room (remote or nearby), per patient, (attention directed exclusively to one patient) each 15 minutes (list in addition to primary procedure)
- Note: G0453 may only be reported for undivided attention by the monitoring physician to a single beneficiary, not for simultaneous attention by the monitoring physician to more than one patient. HCPCS code G0453 may be billed in multiple units to account for the cumulative time spent monitoring, that is, 15 minutes of continuous attendance followed by another 15 minutes later in the procedure would constitute one half hour of monitoring, and CPT code G0453 would be billed with a unit of 2.
- As has been the case previously, the IONM codes should only be reported when the services is done by a professional solely dedicated to performing the intraoperative neurophysiologic monitoring and who is available to intervene at all times during the service as necessary. Other clinical activities beyond providing and interpreting of monitoring cannot be provided during the same period of time. Surgeons should not report these codes for automated monitoring devices that do not require continuous attendance by a professional qualified to interpret the testing and monitoring.
For specific information regarding Relative value units (RVUs) for these new and/or revised services, click here. Should members have any questions regarding the above information in the meantime please contact the Health Policy team.