What ENTs Need to
Know 2015
As the medical community has come to expect, part of the
annual rulemaking process conducted by the Centers for Medicare & Medicaid
Services (CMS) includes the annual issuance of new and modified CPT codes,
developed by the American Medical Association’s (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
Association’s Relative Update Committee (AMA RUC). CMS has the discretion to
accept the RUC’s RVU recommendations for physician work, as well as
recommendations for direct practice expense inputs, or it may exercise its
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 2015. 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 2015:
NEW CODES
In
CY 2015, a new CPT code and/or deleted CPT codes will be announced, including:
·
1 New code to report Endoscopic Zenker’s
Diverticulum (43180).
·
Deletion of three Eustachian tube codes
(69400, 69401, and 69405). To report the work of 69400 or 69405 an
unlisted code, 69799, is recommended. For 69401, the appropriate Evaluation and
Management office visit code is recommended. For more, visit our coding corner
to access the CPT for ENT on this topic.
CODES REVIEWED BY THE AMA RUC in
CY 2014
In
addition to the creation of several new CPT codes for 2015, a number of
existing CPT 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 2015 final rule. Members should be prepared for modified relative value
units for some, or all, of these procedures in CY 2015. It is critical to note
that once the final MPFS is issued by CMS, typically on or about November 1 of
each year. Upon receipt, Academy health policy staff will summarize the final
rule and alert members to any critical changes in reimbursement for any of the
following medical procedures. Services which were reviewed include:
·
92541: Spontaneous nystagmus
test, including gaze and fixation nystagmus, with recording
·
92542: Positional nystagmus
test, minimum of 4 positions, with recording
·
92543: Caloric vestibular test,
each irrigation (binaural, bithermal stimulation constitutes 4 tests), with
recording
·
92544: Optokinetic nystagmus
test, bidirectional, foveal or peripheral stimulation, with recording
·
92545: Oscillating tracking
test, with recording
·
10021*: Fine needle aspiration;
without imaging guidance
·
30903*: Control nasal
hemorrhage, anterior, complex (extensive cautery and/or packing) any method
·
30905*: Control nasal
hemorrhage, posterior, with posterior nasal packs and/or cautery, any method;
initial
·
31295*: Nasal/sinus endoscopy,
surgical; with dilation of maxillary sinus ostium (eg, balloon dilation),
transnasal or via canine fossa
·
31296*: Nasal/sinus endoscopy,
surgical; with dilation of frontal sinus ostium (eg, balloon dilation)
·
31297*: Nasal/sinus endoscopy,
surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation)
·
41530*: Submucosal ablation of
the tongue base, radiofrequency, 1 or more sites, per session
·
30300*: Removal foreign body,
intranasal; office type procedure
·
30906*: Control nasal
hemorrhage, posterior, with posterior nasal packs and/or cautery, any method;
subsequent
·
40804*: Removal of embedded
foreign body, vestibule of mouth; simple
·
42809*: Removal of foreign body
from pharynx
·
69200*: Removal foreign body
from external auditory canal; without general anesthesia
·
69220*: Debridement,
mastoidectomy cavity, simple (eg, routine cleaning)
·
92511*: Nasopharyngoscopy with
endoscope (separate procedure)
*Only practice expense inputs
reviewed by the RUC in 2014, physician work was not surveyed or discussed for
these codes.
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