Emergency Medicine/Urgent Care/Critical Care CPT Updates for 2017

2017 will see many changes to the CPT® code set for emergency medicine/urgent care/critical care. Therefore, coders must gear up for these new codes and steer their practice in the right direction for the upcoming year.

Shorter Time Thresholds

Shorter intra-service time thresholds will be the biggest change to CPT® 2017. The updated intra-service time thresholds have dropped from 30 minutes to 15 minutes. CPT® has instructed that for any time-based code, a time unit is attained when the midpoint is passed, unless there are code- or code range- specific instructions in the guidelines, parenthetical instructions, or code descriptors to the contrary.

New Moderate Sedation Codes

The changes to the CPT® code set will see the deletion of prior moderate (conscious) sedation codes, 99143-99150, which will be replaced with new codes in 2017. To receive full payments, the providers performing moderate sedation with a procedure must now report the appropriate new moderate sedation codes (99151-99157).

The new codes are similar to the prior codes. Three codes describe moderate sedation for situations where (1) sedation is provided supporting your procedure; or (2) when it is for another provider’s procedure. The codes for each scenario include one code for patients under the age of five years, one for age five years and over, and an add-on code for additional time providing moderate sedation. The new codes are as follows:

99151 Moderate sedation services provided by the same physician or other qualified health care professional performing the therapeutic or diagnostic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes intra-service time, patient younger than 5 years of age.
99152 Initial 15 minutes intra-service time, patient age 5 years or older.
99153 Each additional 15 minutes of intra-service time
99155 Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other health care professional performing the therapeutic or diagnostic service that the sedation supports; initial 15 minutes of intra-service time, younger than 5 years of age.
99156 Initial 15 minutes intra-service time, patient age 5 years or older.
99157 Each additional 15 minutes of intra-service time

Further Updates

Additions:

27197 Closed treatment of posterior pelvic ring dislocation(s), fracture(s), diastasis or subluxation of the sacroiliac joint, ilium, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without manipulation.
27198 Closed treatment of posterior pelvic ring dislocation(s), fracture(s), diastasis or subluxation of the sacroiliac joint, ilium, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with manipulation, requiring more than local anesthesia (that is, general anesthesia, moderate sedation, spinal/epidural).
62320 Injection(s), of therapeutic or diagnostic substance(s) (for example, anesthetic, opioid, steroid, antispasmodic, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, thoracic or cervical; without imaging guidance.

Deletions:

11752 Excision of nail and nail matrix, partial or complete (for example, ingrown or deformed nail), for permanent removal; with amputation of tuft of distal phalanx.
21495 Open treatment of hyoid fracture.
22305 Closed treatment of vertebral process fracture(s).

Revisions:

28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant.
31577 Laryngoscopy, flexible; with removal of foreign body(s).
31584 Laryngoplasty; with open reduction and fixation of (for example, plating) of fracture, includes tracheostomy, if performed.

For more insights on the CPT® changes that you might expect in 2017, attend this Webinar by expert speaker Caral Edelberg, CPC, CPMA, CAC, CCS-P, CHC, who leads the overall growth and operational delivery of Edelberg + Associates’ in coding, compliance and education. You will also learn about communicating the importance of updating for the 2017 CPT® changes with your providers.

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