CPT Code Changes for 2014
There are several Current Procedural Terminology® (CPT) code changes for 2014 applicable to otolaryngologists. Below is a summary of these changes. If you have any questions regarding CPT code changes for 2014, please contact the Health Policy team.
CPT Changes for 2014: What ENTs Need to Know
As the medical community has come to expect, part of the annual rulemaking process conducted by the Centers for Medicare and Medicaid Services (CMS) includes the annual issuance of new and modified CPT codes, developed by the American Medical Associations (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 Associations Relative Update Committee (AMA RUC). CMS has the discretion to accept the RUCs 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 2014. 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 2014:
New Codes for 2014
In CY 2014, several new CPT codes will be introduced, including:
- 2 new codes to report flexible, transnasal esophagoscopy (otherwise known as TNE). These services will be reported with CPT codes 43197 and 43198.
- 6 new codes to distinguish between rigid, transoral esophagoscopy procedures and flexible, transoral esophagoscopy. The existing codes will be used to report flexible, transoral procedures, and the new codes CPT 43191-43196 will be used to report rigid, transoral procedures.
- 1 new code to report chemodenervation of the larynx for spasmodic dysphonia. This code will replace the previously reported code CPT 64613. Otolaryngologists will now use CPT 64617 to report all injections to the larynx for the treatment of spasmodic dysphonia.
- 4 new speech evaluation codes. These codes are intended to represent Evaluation of speech fluency (92521); Evaluation of speech sound production (92522); Evaluation of speech sound production with evaluation of language comprehension and expression (92523); and Behavioral and qualitative analysis of voice and resonance (92524).
Codes Reviewed by the AMA RUC
In addition to the creation of several new CPT codes for 2014, 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 2013 final rule. Within the final rule, CMS elected to modify relative value units for some of these procedures in CY 2014. The final MPFS is issued by CMS, typically on or about November 1 of each year; however, the 2014 rule was delayed due to the government shutdown and was released November 27, 2013. Academy health policy staff have summarized the final rule and conducted an analysis on the changes in reimbursement for the following services. Services which were reviewed include:
- 43200: Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing when performed
- 43201: Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance
- 43202: Esophagoscopy, flexible, transoral; with biopsy, single or multiple
- 43215: Esophagoscopy, flexible, transoral; with removal of foreign body
- 43220: Esophagoscopy, flexible, transoral; with balloon dilation (less than 30 mm diameter)
- 43226: Esophagoscopy, flexible, transoral; with insertion of guide wire followed by dilation over guide wire
- 43450: Dilation of esophagus, by unguided sound or bougie, single or multiple passes
- 43453: Dilation of esophagus, over guide wire
- 69210: Removal of Cerumen
- 31237: Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)
- 31238: Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage
- 31239: Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy
- 31240: Nasal/sinus endoscopy, surgical; with concha bullosa resection
Should members have any questions regarding the above information, please contact the Health Policy team.