Vhi Procedure Codes

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Wemaintain and annually update a List of Current Procedural Terminology (CPT)/Healthcare Common Procedure Coding System (HCPCS) Codes (the Code List), which identifies all the items and services included within certain designated health services (DHS) categories or that may qualify for certain exceptions. We update the Code List to conform to the most recent publications of CPT and HCPCS codes and to account for changes in Medicare coverage and payment policies. Code List updates for years 2022 and earlier were published in the Federal Register as an addendum to the annual Physician Fee Schedule final rule.

Beginning with the Code List effective January 1, 2023, updates are published solely on this webpage. On or before December 2nd of each year, we will publish the annual update to the Code List and provide a 30-day public comment period using www.regulations.gov. To be considered, comments must be received within the stated 30-day timeframe. We anticipate that most comments will be addressed by April 1st; however, a longer timeframe may be necessary to address complex comments or those that require coordination with external parties. If no comments are received, in lieu of a comment response, we will publish a note below the applicable Code List year stating so.

We received one comment related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2024. Our response to this comment is below. We also received one comment related to Medicare coverage for platelet-rich plasma treatments. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List.

Comment: One commenter noted that, although most Hepatitis B vaccine codes are identified on the Code List as CPT/HCPCS codes to which the exception for preventive screening tests and vaccines at 411.355(h) applies, the Hepatitis B vaccine associated with CPT code 90739 was not listed. The commenter requested that CPT code 90739 be added to the list of vaccine codes to which the exception for preventive screening tests and vaccines at 411.355(h) applies, effective retroactively to January 1, 2024.

Response: We agree with the commenter that the exception for preventive screening tests and vaccines at 411.355(h) should apply to CPT code 90739 and are revising the Code List accordingly. The applicability of the exception for preventive screening tests and vaccines to CPT code 90739 is prospective only and effective on the date indicated on the UPDATED list of codes.

In considering this comment, we also identified two CPT codes (90653 and 90658, both flu vaccines) that were inadvertently left off of the list of codes to which the exception for preventive screening tests and vaccines at 411.355(h) should apply. Accordingly, we are adding these CPT codes to the list of codes to which the exception at 411.355(h) applies, effective on the date indicated on the UPDATED list of codes.

The comment period ended December 30, 2022. We did not receive any comments related to the additions, deletions, and corrections to the codes on the Code List effective January 1, 2023. We received one (1) comment related to the supervision level required for specific services. We consider this comment to be outside the scope of the annual update. CMS does not respond to out of scope comments on the annual updates to the Code List.

HCPCS Level II: A standardized coding system that is used primarily to identify products, supplies, and services not included in the CPT codes, such as ambulance services or durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) when used outside a physician's office.

CMS has published its HCPCS Application Summaries and Coding Decisions for Quarter 2 (Q2) 2024 Drugs and Biologicals, which includes the Q2 2024 HCPCS Level II applications for drug and biological coding requests. For each application, you can find:

"}},"@type": "Question","name": "Q3: How should facility medical coders use the NHSN procedure code documents for classifying surgical procedures for patient charges?","acceptedAnswer": "@type": "Answer","text": "The NHSN operative procedure code documents, posted on the NHSN site, are not intended to be instructive to medical coders for assigning procedure codes to surgical procedures. The documents are provided as a tool to assist NHSN users participating in SSI reporting with categorizing operative procedures by NHSN procedure categories and to standardize the reporting of surgical procedures between facilities.","@type": "Question","name": "Q4: When are codes updated and how are users notified of updates?","acceptedAnswer": "@type": "Answer","text": "NHSN operative procedure codes are reviewed and updated annually and as needed.

Communication regarding updates to the operative procedure codes are sent via email to individuals and vendors enrolled in NHSN. The emails contain specific details about the updates; therefore, it is critical that all NHSN users review their NHSN user contact information on a regular basis and update as necessary.","@type": "Question","name": "Q5: Are ICD-10-PCS or CPT procedure codes required to enter SSI events into NHSN?","acceptedAnswer": "@type": "Answer","text": "The use of the NHSN operative procedure codes (ICD-10-PCS and/ CPT) is required to determine the correct NHSN operative procedure category but entering the operative procedure code into the NHSN application remains optional.

If the fifth character of the ICD-10-PCS procedure code is a four (4) or F, then the field for scope should be YES.",{"@type": "Question","name": "Q9: When reporting hysterectomy procedures to NHSN, what determines when a procedure is categorized as a vaginal hysterectomy verses an abdominal hysterectomy? Are there definitions for each of these procedures?","acceptedAnswer": {"@type": "Answer","text": "A trained medical coder, using current medical coding guidelines and conventions, should assign the correct procedure code (CPT and ICD-10-PCS) to the hysterectomy procedure.

The hysterectomy procedure approach (5th character of the ICD-10 operative procedure code assigned by a medical coder) identifies whether an abdominal incision was made and determines if the procedure is categorized as a NHSN HYST or VHYS.

The NHSN operative procedure code documents, posted on the NHSN site, are not intended to be instructive to medical coders for assigning procedure codes to surgical procedures. The documents are provided as a tool to assist NHSN users participating in SSI reporting with categorizing operative procedures by NHSN procedure categories and to standardize the reporting of surgical procedures between facilities.

Communication regarding updates to the operative procedure codes are sent via email to individuals and vendors enrolled in NHSN. The emails contain specific details about the updates; therefore, it is critical that all NHSN users review their NHSN user contact information on a regular basis and update as necessary.

The use of the NHSN operative procedure codes (ICD-10-PCS and/ CPT) is required to determine the correct NHSN operative procedure category but entering the operative procedure code into the NHSN application remains optional.

NHSN operative procedure reporting is based on the operative procedure code(s) assigned by a trained medical coder. There are several instructions, guidelines and conventions that govern how and when medical codes are assigned. For questions related to correct procedure code assignment consult with your facility medical coder.

Scope is reported based on the primary incision site. If an open and scope code is assigned to procedures in the same NHSN procedure category, then the procedure should be reported to NHSN as Scope = NO. The open designation is considered a higher risk procedure.

Current Procedural Terminology (CPT) codes provide a uniform nomenclature for coding medical procedures and services. Medical CPT codes are critical to streamlining reporting and increasing accuracy and efficiency, as well as for administrative purposes such as claims processing and developing guidelines for medical care review. The AMA develops and manages CPT codes on a rigorous and transparent process led by the CPT Editorial Panel, which ensures codes are issued and updated regularly to reflect current clinical practice and innovation in medicine. Here you'll find the AMA's latest updates on new CPT codes, code proposals and revisions, CPT code reimbursement and more.

The tables below contain codes for procedures that are frequently included in SEER-Medicare analyses. Please note that NCI provides these codes to assist researchers in analyses. Codes may change or may not be complete. NCI does not accept responsibility for the completeness or currency of the information below. Investigators should check that all relevant codes are included in their analysis.*

In 2005, CMS implemented the Oncology Demonstration Project. For providers participating in the demonstration project, there are specific HCPCS for chemotherapy administration in the physician and hospital outpatient data. (For G0355-G0363, see Medicare drug administration codes (PDF, 253 KB).) There are additional codes related to the assessment of symptoms associated with chemotherapy use (for G9021-G9032, see 2005 Medicare Demonstration Project Chemotherapy Codes). If these G codes are not included in an analysis, use of chemotherapy in 2005 will be underestimated. These codes are to be used in 2005 only.

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