The document summarizes many of the changes to CPT and HCPCS codes for 2016, including additions of new codes for prolonged clinical staff services, esophagogastroduodenoscopy, biliary drainage procedures, nephrostomy procedures, paravertebral nerve blocks, and reflectance confocal microscopy imaging. It also notes deletions of codes in the urinary, vaccine, and drug categories and provides links for full lists of lab, drug, and PQRS code changes.

1. January 1, 2016
2016 CPT Changes

2. Advanced Billing Consultants, Inc.
• This presentation was designed with the clients of
Advanced Billing Consultants in mind. It is not all inclusive.
Please refer to CPT and AMA for a complete listing of all
deletions, additions, and revisions to the code sets.
Disclaimer

3. Advanced Billing Consultants, Inc.
• New:
▫ 99415, 99416: prolonged clinical staff service direct pt
contact w/ phys supervision; beyond 45 mins, plus each
additional 30 mins (not counting the services done like
PT/INR, ect.)
E/M changes

4. Advanced Billing Consultants, Inc.
• New:
▫ 43210: Trans-oral approach for Esophagogastroduodenoscopy
▫ 47537: injection procedure for cholangiography, percutaneous through an existing access
site
▫ 47532: same as 47537 but new access
▫ 47534: placement of biliary drainage catheter
▫ 47535: conversion of external biliary drainage catheter to internal-external biliary
drainage catheter
▫ 47536: exchange of biliary drainage catheter
▫ 47537: removal of biliary drainage catheter
▫ 47538, 47539, 47540: placement of stent into a bile duct
▫ 47541: placement of access through the biliary tree to assist with an endoscopic biliary
procedure
▫ 47542: balloon dilation of biliary ducts to allow for passage of stones (add on code)
▫ 47543: endoluminal biopsy of biliary tree (add on)
▫ 47544: removal of calculi/debris from biliary ducts or gallbladder, any method (add on
code)
▫ 49185: sclerotherapy of a fluid collections, percutaneous
Digestive System

5. Advanced Billing Consultants, Inc.
• Deleted:
▫ 50392, 50393, 50394, 50398
• New
▫ 50430 injection procedure for antegrade nephrostogram and or ureterogram, new access
▫ 50431; existing access
▫ 50432: placement of nephrostomy catheter, percutaneous
▫ 50433; new access
▫ 50434: Convert nephrostomy catheter to nephroureteral catheter
▫ 50435: Exchange nephrostomy
▫ 50606: Endoluminal biopsy of ureter non-endoscopic (add on)
▫ 50693: placement of ureteral stent, percutaneous; pre-existing nephrostomy tract
▫ 50694; new acces, w/o separate nephrostomy catheter
▫ 50695; new acces, with separate nephrostomy catheter
▫ 50705: ureteral occlusion (add on)
▫ 50706: balloon dilation, ureteral stricture (add on)
▫ 54437: repair of traumatic corporeal tear (penis fracture)
▫ 54438: replantation, penis
Urinary System

6. Advanced Billing Consultants, Inc.
• Deleted: 64412-64999
• New:
▫ 64461: paravertebral block, thoracic
▫ 64462; second and any additional injection sites (add on)
▫ 64463; continuous infusion by catheter
Nervous System

7. Advanced Billing Consultants, Inc.
• New
▫ 69209: removal impacted cerumen using irrigation/lavage,
unilateral (when no instrument used- use 69210 if instrument
is used.) Mod 50 allowed
Auditory System

8. Advanced Billing Consultants, Inc.
• There are many changes to Lab codes, for complete list see:
https://www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/ClinicalLabFeeSched/Downloads/CLFS-CY2016-
Preliminary-Payment-Determinations.pdf
• Deleted: G0431, G0434
• New
▫ G0477-G0483: drug screens
Lab Codes

9. Advanced Billing Consultants, Inc.
• Deleted: 13 outdated vaccine codes
• New:
▫ 90625: cholera vaccine
▫ 90697: (DTap-IPV-Hib-HepB)
▫ 90620: Men B 2 dose
▫ 90621: MenB 3 dose
Medicine: Vaccines

10. Advanced Billing Consultants, Inc.
• Deleted: 95973 (95972 revised to remove time element)
• New:
▫ 93050: arterial pressure waveform analysis (replaced 0311T)
▫ 96931-96936: reflectance confocal microscopy imaging of
skin (RCM)
Cardiovascular and Pulmonary

11. Advanced Billing Consultants, Inc.
• There are many changes to drug codes (Q and J). Complete
list can be found at: CMS Level II HCPCS Coding Decisions
for the 2015-2016 Coding Cycle [ZIP, 43KB]
• Deleted: J7302
• New:
▫ J7297: Levonorgestrel-releasing intrauterine contraceptive
system, 52 mg, 3 year duration
▫ J7298; 5 year duration
▫ J1575: Injection, immune globulin/hyaluronidase, 100 mg
immunoglobulin
▫ J0695: Injection, ceftolozane 50 mg and tazobactam 25 mg
Drug Codes

12. Advanced Billing Consultants, Inc.
• There are a lot of new PQRS reporting codes. The complete
list can be found at: 2016 PQRS Measures List
Reporting Codes (G-codes)

13. Advanced Billing Consultants, Inc.
• New
▫ 0381T: external heart rate recordings
▫ 0385T/0386T: more external heart rate recordings
▫ 0387T-0391T: permanent leadless pacemaker
Category III codes

14. Advanced Billing Consultants, Inc.
30021 Tomas, Suite 250
Rancho Santa Margarita, CA 92688
Phone: 888-222-2125
Fax: 949-713-2931
info@advancedbillingconsultants.com