By Lisa Kropp, Coding and Credentialing Manager


Revisions, addition and deletions to the CPT and HCPCS code set are effective January 1, 2015. Use of deleted codes will delay payment, as we will need to “Chart Return” the charge slips to your office for the correct code.

To determine which clients will be impacted by the 2015 changes, we have compared these changes to each client’s procedures performed in 2014.

We will be faxing, mailing or delivering customized reports to our Clients that are impacted by the 2015 CPT changes.

If you would like a complete listing of all the Deleted, New, and Revised Codes, we can provide that upon request.


  • Musculoskeletal System:  Several arthrocentesis codes are revised, others added, to differentiate procedures occurring with or without guidance.  Some new codes describe the same procedures, but include bone biopsy, when performed, plus all imaging guidance.  **Note that the closed treatment of Rib Fracture CPT 21800 has been DELETED for 2015. 
  • Cardiovascular System:
    •  New CPT’s 33270-33273 describe insertion and repositioning of permanent subcutaneous implantable defibrillator components.  **Note that the guidelines for the Pacemaker or Implantable Defibrillator subsection are substantially revised, with nearly two full pages of added text.
  • Digestive System:
    •  CPT 2015 includes dozens of new parenthetical instructions in these sections to help resolve bundling issues and to explain proper code application.
    • New Endoscopy, Stomal subsection includes guidelines encompassing new, revised, and existing codes 44380-44408, which include proctosigmoidoscopy, sigmoidoscopy, colonoscopy, and colonoscopy through stoma.
    • New guidelines specify “When bleeding occurs as a result of an endoscopic procedure, control of bleeding is not reported separately during the same operative session”.
  • Urinary System:
    • Two new codes in the Vesical Neck and Prostrate subsection describe:
      • Cystourethroscopy, with insertion of permanent adjustable trans-prostatic implant; single implant (52441)
      • Each additional implant (+52442)
  • Eye and Ocular Adnexa:
    • New/revised codes describe various procedures pertaining to aqueous shunt, with or without graft.
      • See codes 66179, 66180, 66184, 66185
  • Auditory System:
    • 69400-69401 & 69405 are deleted.  CPT instructs us to use 69799 in place of 69400 & 69405.
    • Trans-nasal Eustachian tube inflation without catheterization is not included in the outpatient E/M codes.
  • Pathology and Laboratory (most noteworthy changes):
    • Extensive guidelines and coding examples accompany the new codes.
    • Tests now divided into two classes as follows:
      • Presumptive drug class procedures: used to identify possible use or non-use of a drug or drug class.  A presumptive test may be followed by a definitive test to specifically identify drugs or metabolites.
      • Definitive drug class procedures: qualitative or quantitative test to identify possible use or non-use of a drug.  These tests identify specific drugs.  Tables are provided to assist with proper code selection.
    • Presumptive drug class codes 80300-80304.  You must identify whether or not a drug falls into “class A” or “class B” as defined by CPT. 
    • Definitive drug class codes – dozens available and are assigned according to the specific substance tested.  Ex. 80324: Amphetamines; 1 or 2
  • Medicine:
    • New Influenza Virus Vaccine code 90630
    • New HPV 3 dose schedule code 90651


Introduction of 4 new HCPCS Level II Modifiers; subsets of distinct procedural services Modifier 59:

  • XE Modifier: Separate encounter i.e. a service that is distinct because it occurred during a separate encounter.
  • XS Modifier: Separate structure i.e. a service that is distinct because it was performed on a separate organ/structure.
  • XP Modifier: Separate Practitioner i.e. a service that is distinct because it was performed by a different practitioner.
  • XU Modifier: Unusual Non-Overlapping Service i.e. the use of a service that is distinct because it does not overlap usual components of the main service

How to report new HCPCS Modifiers:

  • Implementation date is January 5, 2015.
  • CMS will continue to recognize the -59 modifier, but it should NOT be used in addition to these new modifiers because they are more descriptive.
  • CMS may make the use of these modifiers mandatory when used to bill certain codes that are considered at high risk for incorrect billing.
  • These modifiers are valid even before national edits are in place.  Providers are encouraged to use the more selective modifiers. MAC’s are not prohibited from requiring the use of selective modifiers in lieu of the general -59 modifier.

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or<


By Sarah Howarth, Billing Manager

Independent Health

For plan year 2015, Independent Health is adjusting some copayments for primary care and specialists, inpatient stays, X-rays, outpatient surgery and skilled nursing care.  Please check HealtheNet for up-to-date benefit information.


MVP will be implementing the federal premium delinquency guidelines for Advanced Premium Tax Credit (APTC) members.  APTC members delinquent with their payments for less than one month will still be considered eligible and their claims will continue to be paid during the first month of delinquency.

APTC members will remain eligible for up to three months of non-payment.  After the initial month of delinquency, claims will be placed on a pend status.  If the member does not pay their premium by the three month mark, claims will be denied as “member not eligible”.  The patient may be billed directly for services rendered when they are denied for none payment of premium.

For Billing questions, please contact Sarah Howarth at 716-348-3923 or