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IntroductionIntroductionWelcome to Optum360’s Current Procedural Coding Expert, an excitingMedicare coding and reimbursement tool and definitive procedure codingsource that combines the work of the Centers for Medicare and MedicaidServices, American Medical Association, and Optum360 experts with thetechnical components you need for proper reimbursement and codingaccuracy. Handy snap in tabs are included to indicate those sections usedmost often for easy reference.Note: The AMA releases code changes quarterly as well as errata orcorrections to CPT codes and guidelines and posts them on their web site.Some of these changes may not appear in the AMA’s CPT book until thefollowing year. Current Procedural Coding Expert incorporates the mostrecent errata or release notes found on the AMA’s web site at ourpublication time, including new, revised and deleted codes. CurrentProcedural Coding Expert identifies these new or revised codes from theAMA website errata or release notes with an icon similar to the AMA’scurrent new and revised icons. For purposes of this publication, newCPT codes and revisions that won’t be in the AMA book until the nextedition are indicated with a and a icon. For the next year’s edition ofCurrent Procedural Coding Expert, these codes will appear with standardblack new or revised icons, as appropriate, to correspond with thosechanges as indicated in the AMA’s CPT book. CPT codes that were new for2020 and appeared in the 2020 Current Procedural Coding Expert but did notappear in the AMA’s CPT code book until 2021 are identified in appendix Bas “Web Release New and Revised Codes.”PLEThis approach to CPT Medicare coding utilizes innovative and intuitiveways of communicating the information you need to code claimsaccurately and efficiently. Includes and Excludes notes, similar to thosefound in the ICD-10-CM manual, help determine what services are relatedto the codes you are reporting. Icons help you crosswalk the code you arereporting to laboratory and radiology procedures necessary for properreimbursement. CMS-mandated icons and relative value units (RVUs) helpyou determine which codes are most appropriate for the service you arereporting. Add to that additional information identifying age and sex edits,ambulatory surgery center (ASC) and ambulatory payment classification(APC) indicators, and Medicare coverage and payment rule citations, andCurrent Procedural Coding Expert provides the best in Medicare procedurereporting.Coding Expert, see our product update page athttps://www.optum360coding.com/ProductUpdates/. The password for2021 is PROCEDURE2021.General ConventionsMany of the sources of information in this book can be determined bycolor. All CPT codes and descriptions and the Evaluation and Managementguidelines from the American Medical Association are in black text. Includes, Excludes, and other notes appear in blue text. Theresources used for this information are a variety of Medicare policymanuals, the National Correct Coding Initiative Policy Manual (NCCI),AMA resources and guidelines, and specialty association resourcesand our Optum360 clinical experts.MCurrent Procedural Coding Expert includes the information needed tosubmit claims to federal contractors and most commercial payers, and iscorrect at the time of printing. However, CMS, federal contractors, andcommercial payers may change payment rules at any time throughout theyear. Current Procedural Coding Expert includes effective codes that will notbe published in the AMA’s Current Procedural Terminology (CPT) book untilthe following year. Commercial payers will announce changes throughmonthly news or information posted on their websites. CMS will postchanges in policy on its website at http://www.cms.gov/transmittals.National and local coverage determinations (NCDs and LCDs) provideuniversal and individual contractor guidelines for specific services. Theexistence of a procedure code does not imply coverage under any giveninsurance plan.SACurrent Procedural Coding Expert is based on the AMA’s Current ProceduralTerminology coding system, which is copyrighted and owned by thephysician organization. The CPT codes are the nation’s official, HealthInformation Portability and Accountability Act (HIPAA) compliant code setfor procedures and services provided by physicians, ambulatory surgerycenters (ASCs), and hospital outpatient services, as well as laboratories,imaging centers, physical therapy clinics, urgent care centers, and others.Getting Started with Current ProceduralCoding ExpertCurrent Procedural Coding Expert is an exciting tool combining the mostcurrent material at the time of our publication from the AMA’s CPT 2021,CMS’s online manual system, the Correct Coding initiative, CMS feeschedules, official Medicare guidelines for reimbursement and coverage,the Integrated Outpatient Code Editor (I/OCE), and Optum360’s owncoding expertise.These coding rules and guidelines are incorporated into more specificsection notes and code notes. Section notes are listed under a range ofcodes and apply to all codes in that range. Code notes are found underindividual codes and apply to the single code.Material is presented in a logical fashion for those billing Medicare,Medicaid, and many private payers. The format, based on customercomments, better addresses what customers tell us they need in acomprehensive Medicare procedure coding guide.Resequencing of CPT CodesThe American Medical Association (AMA) uses a numbering methodologyof resequencing, which is the practice of displaying codes outside of theirnumerical order according to the description relationship. According to theAMA, there are instances in which a new code is needed within an existinggrouping of codes but an unused code number is not available. In thesesituations, the AMA will resequence the codes. In other words, it will assigna code that is not in numeric sequence with the related codes. However,the code and description will appear in the CPT manual with the otherrelated codes.An example of resequencing from Current Procedural Coding Expert follows:21555#2155221556#21554Excision, tumor, soft tissue of neck or anteriorthorax, subcutaneous; less than 3 cm3 cm or greaterExcision, tumor, soft tissue of neck or anteriorthorax, subfascial (eg, intramuscular); less than 5 cm5 cm or greaterIn Current Procedural Coding Expert the resequenced codes are listed twice.They appear in their resequenced position as shown above as well as intheir original numeric position with a note indicating that the code is out ofnumerical sequence and where it can be found. (See example below.)21554Resequenced code. See code following 21556.Designed to be easy to use and full of information, this product is anexcellent companion to your AMA CPT manual, and other Optum360 andMedicare resources.This differs from the AMA CPT book, in which the coder is directed to a coderange that contains the resequenced code and description, rather than to aspecific location.For mid-year code updates, official errata changes, correction notices, andany other changes pertinent to the information in Current ProceduralResequenced codes will appear in brackets in the headers, section notes,and code ranges. For example: 2021 Optum360, LLCCPT 2021 American Medical Association. All Rights Reserved.i

IndexAbscessSAMPLEAblation — continuedRenalCyst, 50541Mass, 50542Radiofrequency, 50592Tumor, 50593CryotherapyPercutaneous, 50593Supraventricular Arrhythmogenic Focus,33250-33251Tongue BaseRadiofrequency, 41530TumorElectroporation, Irreversible, 0600T,0601TTurbinate Mucosa, 30801, 30802UltrasoundGuidance, 76940Ultrasound Focused, 0071T-0072TUterine Tumor, 0071T-0072TUterusFibroids, 0404T, [58674]Leiomyomata, 0071T-0072TTumorUltrasound, Focused, 0071T-0072TVeinEndovenous, 0524T, 36473-36479[36482, 36483]Ventricular Arrhythmogenic Focus, 33261ABLB Test, 92562ABO, 86900AbortionSee Obstetrical CareIncomplete, 59812Induced byAmniocentesis Injection, 59850-59852Dilation and Curettage, 59840Dilation and Evacuation, 59841Saline, 59850, 59851Vaginal Suppositories, 59855, 59856with Hysterotomy, 59100, 59852, 59857MissedFirst Trimester, 59820Second Trimester, 59821Septic, 59830Spontaneous, 59812Therapeutic, 59840-59852by Saline, 59850with Dilatation and Curettage,59851with Hysterotomy, 59852Abrasion, SkinChemical Peel, 15788-15793Dermabrasion, 15780-15783Lesion, 15786, 15787ABS, 86255, 86403, 86850AbscessAbdomen, 49040Drainage, 49020, 49040PeritonealOpen, 49020Peritonitis, Localized, 49020RetroperitonealOpen, 49060Skin and Subcutaneous TissueComplicated, 10061Multiple, 10061Simple, 10060Single, 10060SubdiaphragmaticOpen, 49040Subphrenic, 49040Incision and DrainageOpen, 49040AnalIncision and Drainage, 46045, 46050AnkleIncision and DrainageBone Abscess, 27607Deep Abscess, 27603Hematoma, 27603AppendixIncision and Drainage, 44900Arm, Lower, 25028Bone Abscess, 25035Excision, 25145 2021 Optum360, LLCCPT 2021 American Medical Association. All Rights Reserved.[Resequenced]Index — 1-10, 11-Epoxide — AbscessAbdominohysterectomyRadical, 58210Resection of Ovarian Malignancy, 58951,58953-58954, 58956Supracervical, 58180Total, 58150, 58200with Colpo-Urethrocystopexy, 58152with Omentectomy, 58956with Partial Vaginectomy, 58200Abdominoplasty, 15830, 15847, 17999ABG, 82803, 82805ABL1, 81401AblationAnalPolyp, 46615Tumor, 46615Atria, 33254-33259Bone Tumor, 20982-20983Breast Tumor, 0581TColonPolyp(s) or Tumor(s), [44401], [45346],[45388]CryosurgicalBreast Tumor, 0581TFibroadenoma, 19105Liver Tumor(s), 47381Nerve, 0440T-0442TRenal Mass, 50250Renal TumorPercutaneous, 50593CT Scan Guidance, 77013Endometrial, 58353, 58356, 58563EndometriumUltrasound Guidance, 58356EndoscopicDuodenum/Jejunum, [43270]Esophagus, 43229, [43270]Hepatobiliary System, [43278]Stomach, [43270]Endovenous, 0524T, 36473-36479 [36482,36483]Fractional Laser FenestrationInfants and Children, 0479T-0480THeartArrhythmogenic Focus, 93650-93657Intracardiac Catheter, 93650-93657Open, 33250-33261Intracardiac Pacing and Mapping, 93631Follow-up Study, 93624Stimulation and Pacing, 93623LiverTumor, 47380-47383AblationCryoablation, 47381, 47383Radiofrequency, 47380, 47382Laparoscopic, 47370-47371Cryosurgical, 47371Open, 47380-47381LungTumorCryoablation, [32994]Radiofrequency, 32998Magnetic Resonance Guidance, 77022NerveCryoablation, 0440T-0442TPercutaneous, 0632TOpen Wound, 0491T-0492TParenchymal TissueCT Scan Guidance, 77013Magnetic Resonance Guidance, 77022Ultrasound Guidance, 76940Prostate, 55873High Intensity-focused Ultrasound (HIFU)Transrectal, 55880High-energy Water Vapor Thermotherapy, 0582TTransurethral Waterjet, 0421TPulmonary TumorCryoablation, [32994]Radiofrequency, 32998RadiofrequencyLiver Tumor(s), 47382Lung Tumor(s), 32998Renal Tumor(s), 50592Tongue Base, 41530IndexAbdomen, Abdominal — continuedExcision — continued-10, 11-Epoxide, [80161]Tumor, Abdominal Wall, 229003-Beta-Hydroxysteroid Dehydrogenase Type IIExploration, 49000-49084Deficiency, 81404Blood Vessel, 358403-Methylcrotonyl-CoA Carboxylase 1, 81406Staging, 589605,10-Methylenetetrahydrofolate Reductase,Hernia Repair, 49491-49590, 49650-49659[81291]Incision, 49000-49084Staging, 58960AIncision and DrainagePancreatitis, 48000A, C, Y, W-135 Combined Vaccine, 90733-90734Infraumbilical Panniculectomy, 15830A Vitamin, 84590InjectionAbbe–Estlander Procedure, 40527, 40761Air, 49400ABBI Biopsy, 19081-19086Contrast Material, 49400ABCA4, 81408InsertionABCC8, 81401, 81407Catheter, 49324, 49418-49421ABCD1, 81405Venous Shunt, 49425Abdomen, AbdominalIntraperitonealAbscess, 49020, 49040Catheter Exit Site, 49436Incision and DrainageCatheter Insertion, 49324, 49418-49421,Skin and Subcutaneous Tissue,49425, 4943510060-10061Catheter Removal, 49422Open, 49040Catheter Revision, 49325Peritoneal, 49020ShuntPeritonitis, Localized, 49020Insertion, 49425Retroperitoneal, 49060Ligation, 49428Subdiaphragmatic, 49040Removal, 49429Subphrenic, 49040Revision, 49426Angiography, 74175, 75635Laparoscopy, 49320-49329AortaLaparotomyAneurysm, 34701-34712 [34717, 34718],Exploration, 47015, 49000-49002, 5896034813, 34830-34832, 34841Hemorrhage Control, 4900234848, 35081-35103Reopening, 49002Angiography, 75635Second Look, 58960Aortography, 75625, 75630Staging, 58960Thromboendarterectomy, 35331with Biopsy, 49000Aortic Aneurysm, 34701-34712 [34717,34718],Lymphangiogram, 75805, 7580734813, 34830-34832, 34841-34848,Magnetic Resonance Imaging (MRI), 7418135081-3510374183ArteryFetal, 74712-74713Ligation, 37617Needle BiopsyBiopsyMass, 49180Incisional, 11106-11107Pancreatitis, 48000Open, 49000Paracentesis, 49082-49083Percutaneous, 49180Peritoneal Abscess, 49020Punch, 11104-11105Peritoneal Lavage, 49084Skin, Tangential, 11102-11103Placement Guidance Devices,

changes as indicated in the AMA's CPT book. CPT codes that were new for 2020 and appeared in the 2020 Current Procedural Coding Expert but did not appear in the AMA's CPT code book until 2021 are identified in appendix B as "Web Release New and Revised Codes." General Conventions