The document summarizes changes to CPT codes for 2014, focusing on new codes, deleted codes, and code revisions. Key changes included 107 new Category I codes, 40 deleted Category I codes, and 103 revised Category I codes. There were also changes to codes related to evaluation and management, integumentary procedures, musculoskeletal procedures, and cardiovascular procedures. Physicians are responsible for understanding coding changes and ensuring accurate billing.

2. Disclaimer
Current Procedural Terminology (CPT) is copyright © 2014 American Medical
Association. All rights reserved.
This document will highlight the changes for CPT codes in 2014, but will not include
ALL changes. Our goal is to help you understand new codes and the reasoning for
some of the organizational changes to CPT.
It is every individual’s responsibility to read and absorb the changes in the CPT manual
every year.
Although every reasonable effort has been made to assure the accuracy of the
information within this document, the ultimate responsibility for the correct
submission of claims and response to any remittance advice lies with the provider
of services.

3. The Changes
Category I Codes
• 107 New
• 40 Deleted
• 103 Revised
Resequenced
Code
Category II
Code
• Now total 120
(16 added)
• 47 New
• 1 Revised

4. Change Management
Comb through the CPT book for all code changes and
instructions that impact your practice.
– Train Coders on change requirements
– Train Physicians on documentation requirements
– Inform your Billing Dept. so that an impact analysis can be performed

5. Evaluation & Management
No deletions
No revisions
New guidelines
– Neonatal Intensive Care Unit
(NICU), complex and transitional
care services reporting neutrality
Six new codes

6. Evaluation & Management
NICU/Pediatric Critical care
New guidelines
– Services included during pediatric patient transport that may not be
reported separately:
• Routine monitoring evaluations, interpretation of cardiac output measurements, pulse
oximetry, blood gases and information data stored in computers, gastric intubation,
temporary transcutaneous pacing, ventilatory management, vascular access procedures.
– Only the communication time spent by the supervising physician is
reported for 99485

7. Evaluation & Management
Complex Chronic Care Coordination Services
New guidelines
• Editorial revisions defining patient population, practice
capabilities, the care plan, and reporting requirements.
• Defines care plan as including physical, mental, cognitive, social,
functional and environmental assessment, with problem list,
expected outcome and prognosis, measurable treatment goals,
symptom management, interventions, medication management,
community social services ordered, timeline for review, and any
revisions.

8. Evaluation & Management
A new category of E&M services has been introduced in CPT
2014
• Interprofessional telephone/internet assessment and
management services
• What is it?
– A non-face-to-face patient assessment and management service by a
physician with specific specialty expertise, requested by the patient’s
attending/primary MD/QHP.
– Typically provided in complex and/or urgent situations that do not
allow for a timely face-to-face service (eg, distance)
New codes 99446 - 99449

9. Evaluation & Management
New codes
• 99446 - Interprofessional telephone/Internet assessment and
management service provided by a consultative physician including a
verbal and written report to the patient’s treating/requesting physician or
other qualified health care professional; 5-10 minutes of medical
consultative discussion and review
– 99447 11-20 minutes of medical consultative discussion and review
– 99448 21-30 minutes of medical consultative discussion and review
– 99449 31 minutes or more of medical consultative discussion and
review

10. Evaluation & Management
Who reports it?
– The physician with specific specialty expertise (the consultant) who:
• Has not had a face-to-face encounter with the patient within the
last 14 days
• Cannot accept transfer of care until after the consultation
What is included? Review of:
•
•
•
•
•
Pertinent records
Laboratory studies
Imaging studies
Medication profile
Pathology specimens
– Greater then 50% of the time reported must be devoted to medical
consultative verbal/internet discussion

11. Evaluation & Management
How are the codes reported?
– Only one code should be reported by
the consultant
– Code is chosen based on the time
spent for the entirety of the service
– Should not be reported more than
once in a 7 day period
• However, if more than one
telephone/internet contact is
required to complete the service –
report a single code for the
cumulative discussion and
information review time.

12. Evaluation & Management
New codes
Inpatient Neonatal and Pediatric Critical Care
– 99481 Total body systemic hypothermia in critically ill neonate per day
(List separately in addition to code for primary procedure)
– 99482 Selective head hypothermia in a critically ill neonate per day
(List separately in addition to code for primary procedure)

13. Evaluation & Management
Inpatient Neonatal and Pediatric Critical Care
How are the codes reported?
– Therapeutic hypothermia for brain injury caused by birth asphyxia and
hypoxic ischemic encephalopathy (HIE)
– For example, 33 degrees C (91.4 degrees F) for 72 hours
– Cool-Cap® system (99482)
– These are add-on codes
– Codes out of sequence, following 99476

14. Integumentary
New image-guided drainage
code
Complex repair deletion
Breast excision revisions
regarding guidance

15. Integumentary
New code
• 10030
Image-guided fluid collection drainage by catheter (eg,
abscess, hematoma, seroma, lymphocele, cyst), soft tissue
(eg, extremity, abdominal wall, neck), percutaneous
Deleted code
• 13150
Repair, complex, eyelids, nose, ears and/or lips;
1.0 cm or less

16. Integumentary
Breast Excision
Code changes
– Nine new comprehensive codes have replaced the existing biopsy
(19102/19103), clip (19295), and localization (19290/19291)
procedure codes.
– Procedure codes will now include any procedures commonly
performed at the time of biopsy (clip placement, specimen radiograph,
etc.)
– Codes are based on the type of radiologic guidance, which is now
included in the code, and also based on the number of lesions treated.

17. Integumentary
Breast Excision
Code changes
– Codes 19102, 19103, 19290, 19291, 19295, and imaging guidance
codes 77031 and 77032 have been deleted
– Replaced with new bundled breast biopsy codes 19081 – 19086 and
new bundled breast localization device codes 19281 - 19288

18. Musculoskeletal
Overview
– Revised introductory guidelines
• Excision of subcutaneous soft tissue tumors
• Radical resection of soft tissue tumors
– New codes for removal of FB shoulder, deep and removal of prosthesis
humeral and/or glenoid
– Revised codes for removal of prosthesis humeral and ulnar
components
– New cross-references

19. Musculoskeletal
Excision of subcutaneous soft connective tissue tumors
Introductory guideline changes
– “(including simple or intermediate repair) involves the simple or
marginal resection of tumors confined to subcutaneous tissue below
the skin but above the deep fascia. These tumors are usually benign
and are resected without removing a significant amount of
surrounding normal tissue.”

20. Musculoskeletal
Radical resection of soft connective tissue tumors
Introductory guideline changes
– “(including simple or intermediate repair) involves the resection of the
tumor with wide margins of normal tissue. Appreciable vessel
exploration and/or neuroplasty repair or reconstruction (eg, adjacent
tissue transfer[s], flap[s]) should be reported separately.”
– “Extensive undermining….may require a complex repair which should
be reported separately.”
– “Dissection or elevation of tissue planes to permit resection of the
tumor is included in the excision.”

21. Musculoskeletal
Shoulder prosthesis
– Codes 23331 and 23332 were deleted
– Three new codes 23333 (FB removal shoulder, deep), 23334, 23335
• Created to delineate between removal of foreign body and
prosthesis
• 23334 (one component, Humeral or Glenoid)
• 23335 (both components) Humeral and Glenoid (total shoulder)

22. Musculoskeletal
Elbow prosthesis
– Codes 24160 and 24164 were revised
– Specify removal of prosthesis, including debridement and
synovectomy “when performed”
Application of Casts and Strapping
– Lower Extremity codes 29581 and 29582 were revised
– New parenthetical regarding what these codes CANNOT be reported in
addition to.

23. Cardiovascular
Aortic Valve
– Cat III code 0318T was deleted and replaced with Cat I code;
• 33366, Transcatheter aortic valve replacement (TAVR/TAVI) with
prosthetic valve; transapical exposure (eg, left thoracotomy)
• Guidelines were updated to include the new code

24. Cardiovascular
Revised codes
33222 Revision or Relocation of skin pocket
for pacemaker
33223 Revision or Relocation of skin pocket
for cardioverter-defibrillator
• Revisions are reported with appropriate
integumentary codes or with pacemaker
insertion or replacement codes
• Note new implant codes for
subcutaneous defibrillator systems,
0319T-0339T

25. Cardiovascular
Arteries and Veins
• New subsection & guidelines
– Deleted Cat III codes 0078T – 0081T
• New Cat I codes 34841 – 34848
– Fenestrated Endovascular Repair of the Visceral and Infrarenal Aorta
(FEVAR)

26. Cardiovascular
Fenestrated Endovascular Repair of the Visceral and
Infrarenal Aorta
(34841-34848)
– Fenestrate: to make an opening
– Visceral and infrarenal aorta: aorta distal to the diaphragm (abdominal
aorta) from which arteries divide to nourish the abdominal organs
– Code choice based on number of endoprostheses, and site
– Previously reported with 0078T and 0081T (deleted)

27. Cardiovascular
New codes
– Fenestrations (window) allow for selective catheterization of the
visceral and/or renal arteries and subsequent placement of an
endoprosthesis
– Codes 34841 – 34844 and 34845 – 34848 define the total number of
visceral and/or renal arteries requiring placement of an
endoprosthesis through an aortic endograft fenestration
– Codes 34841 – 34844 report deployment of a fenestrated
endoprosthesis that spans from the visceral aorta through the
infrarenal aorta and does NOT extend into the common iliac arteries
– Codes 34845 – 34848 report deployment of a fenestrated
endoprosthesis that spans from the visceral aorta through the
infrarenal aorta into the common iliac arteries

28. Cardiovascular
Codes 34841 – 34848 include:
– Placement of unilateral or bilateral docking limbs (depending on the
device) into the iliac system
– Any additional stent graft extensions that terminate in the aorta
(34841-34844) or in the common iliac (34845 – 34848)
– Proximal abdominal aortic extension prosthesis(es)
– Introduction of guide wires and catheters non-selectively into the
aorta and selectively into the visceral and/or renal arteries.
– Balloon angioplasty within the target treatment zone of the endograft,
either before or after deployment
– Fluoroscopic guidance and radiological supervision and interpretation
in conjunction with fenestrated endovascular aorta repair

29. Cardiovascular
Codes 34841 – 34848 don’t include:
– Distal extension prosthesis(es) that terminate in the internal iliac, or
common femoral artery(s)
– Catheterizations of the hypogastric artery(s) and/or arterial families
outside the treatment zone of the graft
– Exposure of the access vessel (eg, 34812)
– Extensive repair of an artery (eg, 35226, 35286)
– Interventional procedures performed at the time of fenestrated
endovascular abdominal aortic aneurysm repair

30. Cardiovascular
New code
37217
Transcatheter placement of intravascular stent(s), intrathoracic
common carotid artery or innominate artery by retrograde
treatment
– Approach against the flow of arterial blood
– Typically via open ipsilateral cervical carotid exposure
– Includes angioplasty, radiological S&I

31. Cardiovascular
37212 includes:
– Carotid artery open surgical exposure and standard closure of the
arteriotomy by suture
– All retrograde access and catheterization of the vessel, traversing the
lesion
– Any radiological supervision and interpretation directly related to the
intervention when performed ( i.e., includes diagnostic angiogram)
– Imaging performed to document completion of the intervention in
addition to the intervention(s) performed (i.e., the stenting and
angioplasty)

32. Cardiovascular
37217 does not include:
– Carotid artery revascularization services (eg, 33891, 35301, 35509,
35510, 35601, 35606) performed during the same session may be
reported separately, when performed

33. Cardiovascular
Endovascular Stent Placement (Open or Percutaneous),
Transcatheter
Code changes
– Codes 37205 – 37208, 75960 were deleted
– New codes 37236 – 37239
– Codes 37236, 37237 describe transluminal intravascular stent
insertion in an artery
– Codes 37238, 37239 describe transluminal intravascular stent
insertion in a vein
– Report codes 37237 and/or 37239 as appropriate, when additional,
separate and distinct vessels are treated in the same session

34. Cardiovascular
Codes 37236 – 37239 include:
– All balloon angioplasty(s) performed in the treated vessel including
treatment of a lesion outside the stented segment but in the same
vessel
– Any pre-dilation (whether performed as a primary or secondary
angioplasty ie, failed PTA requiring stent salvage
– Post-dilation following stent deployment
– Use of larger/smaller balloon to achieve therapeutic result
– Radiological supervision and interpretation directly related to the
intervention(s) performed
– Closure of arteriotomy by pressure, application of an arterial closure
device or standard closure of the puncture by suture
– Imaging performed to document completion of the intervention

35. Cardiovascular
Codes 37236 – 37239 don’t include:
– Angioplasty in a separate and distinct vessel
– Non-selective and/or selective catheterization(s) (eg, 36005, 3601036015, 36200, 36215-36218, 36245-36248)
– Extensive repair or replacement of an artery (eg, 35226 or 35286)
– Ultrasound guidance (76937) for vascular access
– Intravascular ultrasound (ie, 37250, 37251)
– Initial diagnostic angiography (as defined under “Vascular Procedures”
in the CPT Radiology section)

36. Cardiovascular
New codes
37241
37242
Vascular embolization or occlusion, inclusive of all radiological
supervision and interpretation, intraprocedural road mapping,
and imaging guidance necessary to complete the intervention;
venous, other than hemorrhage (eg, congenital or acquired venous
malformations, venous and capillary hemangiomas, varices,
varicoceles)
arterial, other than hemorrhage or tumor (eg, congenital
or
acquired arterial malformations, arteriovenous
malformations,
arteriovenous fistulas, aneurysms, pseudoaneurysms)
37243
for tumors, organ ischemia, or infarction
37244
for arterial or venous hemorrhage or lymphatic extravasation

37. Digestive
Deleted abscess drainage codes
–
–
–
–
–
32201 (pneumonostomy code discussed in Respiratory section)
44901 Incision and drainage of appendiceal abscess; percutaneous
47011 Hepatotomy; for percutaneous drainage of abscess or cyst, 1 or 2 stages
48511 External drainage, pseudocyst of pancreas; percutaneous
49021 Drainage of peritoneal abscess or localized peritonitis, exclusive of
appendiceal abscess; percutaneous
– 49041 Drainage of subdiaphragmatic or subphrenic abscess; percutaneous
– 49061 Drainage of retroperitoneal abscess; percutaneous
(Urinary/Female)
– 50021 Drainage of perirenal or renal abscess; percutaneous
– 58823 Drainage of pelvic abscess, transvaginal or transrectal approach,
percutaneous (eg, ovarian, pericolic)

38. Digestive
New drainage codes
Abdomen, Peritoneum, and Omentum
49405
49406
49407
Image-guided fluid collection drainage
by catheter (eg, abscess, hematoma,
seroma, lymphocele, cyst); visceral (eg,
kidney, spleen, lung/mediastinum),
percutaneous
peritoneal or retroperitoneal,
percutaneous
peritoneal or retroperitoneal, transvaginal or
transrectal

39. Digestive
26 new, 41 revised, 17 deleted codes – Selection based on
–
–
–
–
Approach: Transoral or transnasal
Scope: Flexible or rigid
Additional clarity to procedure performed
Some new concepts
• Most comprehensive change in CPT this year

40. Digestive
Two new transnasal esophagoscopy (TNE) codes:
– 43197 and 43198
– Performed to evaluate the esophagus from its inlet through the
gastroesophageal junction.
– Includes the nasal cavity (one or both sides), nasopharynx,
hypopharynx, and the larynx

41. Digestive
Transoral esophagoscopy
– In 2013 – codes 43200 – 43232 described either rigid or flexible
transoral esophagoscopy
– In 2014, rigid and flexible transoral esophagoscopy procedures have
been separated into two distinct code families;
• 43200 – 43232 flexible scope
• 43191 – 43196 rigid scope

42. Digestive
Endoscopic Mucosal Resection (EMR)
Two new codes
– 43211 - esophagoscopy
– 43254 - EGD
• EMR can include injection-assisted, cap-assisted, and ligation-assisted
techniques
• All techniques involve;
– Identification and demarcation of the lesion;
– Submucosal injection to lift the lesion, and
– Endoscopic snare resection

43. Digestive
Esophagoscopy, EGD, and ERCP
Code changes
– Stent placement codes 43219, 43256, 43268 were deleted
– New codes added that include pre/post-dilation and guidewire
passage, when performed
• 43212 – esophagoscopy
• 43266 – EGD
• 43274 – ERCP (includes sphincterotomy)
– Code 43241 was revised for consistency

44. Digestive
Dilation
Code changes
– 43220 (esophagoscopy) and 43249 (EGD)
• Revised to specify transendoscopic balloon dilation <30 mm in
diameter
– 43214 (esophagoscopy) and 43233 (EGD)
• New codes added for upper endoscopy with balloon dilation of ≥
30 mm
• Fluoroscopic guidance is included
• High risk services due to size of balloon and risk of perforation
– Code 43456 was deleted, replaced with 43213
• Esophagoscopy, retrograde dilation, fluoroscopy is included

45. Digestive
EGD with endoscopic ultrasound (EUS)
– Codes 43237, 43238 revised
• Report if EUS is performed of the esophagus, stomach OR
duodenum and adjacent structures
– Codes 43242, 43259 revised
• Report if EUS is performed of the esophagus, stomach AND
duodenum, or
• A surgically altered stomach where the jejunum is examined distal
to the anastomosis

46. Neurology
•
•
•
•
Chemodenervation
Deletion of codes 64613, 64614
New codes 64616, 64617, 64642 – 64647
New and revised parenthetical notes

47. Neurology
Code 64616 added to describe chemodenervation of neck
muscle other than muscles of the larynx
• Describes a unilateral procedure, for bilateral services
append modifier 50
– Parenthetical directs coder to 95873 and 95874 for chemodenervation
guided by a needle EMG or performed by muscle electrical
stimulation.
– It would not be appropriate to report more than one guidance code
for any unit of 64616.

48. Neurology
64617 – same unilateral/bilateral guidance as
64616
– Includes all intralaryngeal muscles that might be injected
– Includes local-topical anesthesia, if used
– EMG guidance is included in code descriptor
• Diagnostic EMG of larynx is coded 95865

49. Neurology
Chemodenervation – Extremity
– New codes, guidelines and parenthetical notes added to report these
codes
• Codes 64642 – 64645 are reported once per extremity
• Report only one base code(s), i.e. 64642 or 64644 per session
• Report one or more units of add-on codes 64643 or 64645 for each
additional extremity injected
– Document what muscle(s) were injected and how many units of Botox
was administered in each injection

50. Neurology
Chemodenervation – Trunk muscle(s)
– Two new codes; 64646 and 64647
– Parenthetical note added to direct the user to report either 64646 or
64647 once per session
– There is no bilateral code or modifier allowed, just count the total
number of trunk muscles injected
• 64646 = 1 – 5 muscle(s)
• 64647 = 6 or more muscles

51. Ophthalmology
Surgery – Eye and Ocular Adnexa
– Codes 65778 and 65779 were
revised
– The phrase “for wound healing” was
removed because it restricted the
use of these codes for this purpose
• The amniotic membrane is also
utilized for protection of the
transplanted cornea from
infection and for promotion of
wound healing
– Substitute the term “self-retaining”
with the term “without sutures”

52. Ophthalmology
Anterior Sclera
– Aqueous Shunt
– New code 66183, replaced Cat. III code 0192T
• Added to report the insertion of an anterior segment drainage
device for the management of glaucoma using an external surgical
approach.
• Placed to relieve intraocular pressure associated w/glaucoma that
is not responding to medical therapy or surgical interventions (eg,
laser trabeculoplasty).

53. Otolaryngology
Code revision – 69210 removal of impacted cerumen
– “Removal impacted cerumen requiring instrumentation, unilateral”
– Requires use of instrumentation and generally magnification (eg,
otoscope, operating microscope) to physically remove the cerumen

54. Radiology
Code 72040
– Revised to include the exact
number of views to eliminate
overlap in the coding structure
• 72040 Radiologic
examination, spine, cervical;
2 or 3 views
• 72050 4 or 5 views
• 72052 6 or more views

55. Radiology
• Radiation Oncology
– Description of Simulation is now included in the guidelines
– Definitions for the three categories of Simulation are now included in
the guidelines
– Code 77295 is now listed under “Medical Radiation Physics, Dosimetry,
Treatment Devices, and Special Services”
– New add-on code 77293 is now listed under “Clinical Treatment
Planning (External and Internal Sources)”

56. Pathology & Laboratory
Therapeutic Drug Assays
– Ten new codes added to identify drug assay procedures
– As stated in the existing Therapeutic Drug Assay guidelines, the
material tested may be from any source and are quantitative in nature
– Anticipated major changes in drug testing codes for 2015

57. Pathology & Laboratory
Molecular Pathology
– Tier 1
• Now contains 107 codes
– Tier 2 – Code revisions (analyte additions to each level):
• 81400 – 81408
• Editorial revisions to existing codes to include additional analytes
determined to fall under Tier 2 reporting

58. Pathology & Laboratory
81400
9 additions
81401
24 additions
81402
1 additions
81403
19 additions
81304
52 additions
81405
84 additions
81406
91 additions
81407
24 additions
81408
14 additions

59. Medicine
• Vaccine, Toxoids
– New code 90673 – established for a trivalent recombinant DNA
influenza vaccine (FDA approval 1/2013)
• Four new quadrivalent influenza virus vaccine codes
• 90685 – 90688
• Quadrivalent; two type A strains and two type B strains
• Codes distinguish between infants and young children and
individuals 3 years of age an older, as well as with and without
preservatives

60. Medicine
Gastroenterology
Code 91065 was revised
– Includes methane testing
• Used to measure end-expiratory breath specimens
– Parenthetical instruction added instructing the user to report this code
once for each test administered

61. Medicine
Special Otorhinolaryngologic Services
Code 92506 was deleted (lacked specificity)
• Four new codes
– 92521 – 92524
– Directly relate to the evaluation of speech fluency, speech sound
production, language comprehension, and expression, and analysis of
voice and resonance

62. Medicine
Cardiovascular
Repair of Structural Heart Defect
– New code 93582 was established to report percutaneous
transcatheter closure of a patent ductus arteriosus (PDA)
• Congenital disorder
• Failure of the ductus arteriosus connecting the aorta to the
pulmonary artery fails to close normally after birth
• Causes excess blood flow through the lungs resulting in undue
strain on the heart
• Large PDA openings left untreated can lead to heart failure and
death

63. Medicine
New code 93583 – established to report
transcatheter septal reduction therapy
– (eg, alcohol septal ablation)
– Minimally invasive procedure to reduce septal thickness to improve
left ventricular outflow tract obstruction
• Patients with hypertrophic cardiomyopathies

64. Medicine
Intracardiac Electrophysiological Procedures/Studies
– Codes revisions for 93653 and 93656
• “when possible” changed to “when necessary”
• “bundle” was added to His, i.e. His bundle (His bundle was
included in 93656)
• Updated parentheticals
– 93654 only parenthetical revisions

65. Medicine
Active Wound Care Management
– Cat III code 0183T was deleted and replaced with new code 97610
• Low frequency, non-contact, non-thermal ultrasound
• Modality used to promote the healing of wounds (such as pressure
ulcers) using acoustic or sound energy to atomize saline and
deliver ultrasound energy by way of a continuous mist to the
wound bed and surrounding tissue.
• Includes topical application(s), when performed, wound
assessment, and instruction(s) for ongoing care, per day

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