51101 …by trocar or intracatheter
51102 …with insertion of suprapubic catheter
If you have the old codes for bladder aspiration memorized, relearn them. Once again, CPT tinkered with placement of codes and decided that bladder aspiration codes are placed more appropriately under “Bladder, Removal” than “Bladder, Incision.” The uses of those codes are unchanged.
Giving flu, HPV vaccines
90661 Influenza virus vaccine, derived from cell cultures, subunit, preservative and antibiotic free, for intramuscular use
90662 Influenza virus vaccine, split virus, preservative free, enhanced immunogenicity via increased antigen content, for intramuscular use
90663 Influenza virus vaccine, pandemic formulation
90650 Human papillomavirus (HPV) vaccine, types 16 and 18, bivalent, 3-dose schedule, for intramuscular use
Four new codes for vaccines can be reported beginning January 1, but only those for the influenza vaccine appear in the CPT 2008 book. The code for the new bivalent HPV vaccine is a valid code for 2008 but will not appear in print until CPT 2009.
Changes made to “modifier -51” exemptions
CPT 2008 also reassessed codes that have been designated as “modifier - 51 exempt.” Typically, these are codes that do not involve significant preoperative or postoperative work. 36660 [catheterization, umbilical artery, newborn, for diagnosis or therapy] now requires a modifier when performed with other procedures, whereas 51797 [voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal)] becomes an add-on code that does not take a modifier -51. Beginning January 1, 51797 can be billed only if 51795 [voiding pressure studies (VP); bladder voiding pressure, any technique] has also been reported.
Fecal blood testing
If you bill 82272 [blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, single specimen (e.g., from digital rectal exam)] for the annual fecal occult blood screening test, CPT has revised the code to make it clear that this code is not to be reported for a screening test.
The only two CPT codes that can be reported for the screening fecal occult blood test are 82270 [blood, occult, by peroxidase activity (e.g., guaiac), qualitative, feces, consecutive collected specimens with single determination, for colorectal neoplasm screening] (that is, the patient was provided three cards or a single triple card for consecutive collection) or 82274 [blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1–3 simultaneous determinations].
Note: The physician may collect the specimen for an immunoassay (except on a Medicare patient), but a guaiac test specimen must be collected by the patient.
Cervical biopsy
The descriptor for 57500 will now specifically refer to the cervix as the location for biopsy or excision of a lesion. Before this change, only the subheading title gave any indication of anatomic location.
Hysterectomy
If you perform a laparoscopic-assisted (58550–58554), total (58570–58573), or supracervical (58541–58544) hysterectomy, CPT has added a list of codes that you may not report as well. These include:
- 49320 [diagnostic laparoscopy]
- 57000 [colpotomy]
- 57180 [hemostatic vaginal packing]
- 57410 [EUA]
- 58140–58146, 58545–58546, 58561 [myomectomy]
- 58661 [removal of tubes and/or ovaries]
- 58670, 58671 [tubal ligations]
Vascular ultrasound
Last, CPT has clarified that, to bill 93975 or 93976 [duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs], the purpose of the exam must be to evaluate vascular structures. If color Doppler ultrasound is used to identify anatomic structures at the time of US scan, neither of those two codes may be billed additionally.