December 10, 2018
Area(s) of Interest: Practice Management
“Coding Corner” focuses on coding, compliance, and documentation issues relating specifically to physician billing. This month’s tip comes from G. John Verhovshek, the managing editor for AAPC, a training and credentialing association for the business side of health care.
CPT® 2019 includes over 200 new Category I and III codes, including major changes in nearly every section of the codebook, except anesthesia. Here’s a review of some of the more significant changes.
You will now be able to append modifier 63 Procedure performed on infants less than 4 kgs to select Medicine/Cardiovascular (90000-series) codes to describe increased complexity of procedures performed on patients of less than 4 kg (approx. 8.8 lb.). CPT® does not allow modifier 63 for procedures involving congenital anomalies, or those valued to reflect heightened complexity associated with prematurity (see Appendix F of CPT® for a a complete list of modifier 63 exempt codes).
Regarding evaluation and management (E/M) services, CPT® 2019 introduces two codes to report remote physiologic monitoring services (e.g., weight, blood pressure, pulse oximetry) during a 30-day period: 99453 for device set-up and patient education, and 99454 for supply of the device with daily recording or programmed alert transmissions.
Additionally, 99457 is added to report remote physiologic monitoring treatment management services, for use when “patients or the practice do not meet the requirements to report more specific services.”
New chronic care management code 99491 describes a qualified provider’s time to establish, implement, revise or monitor the care plan for a patient with two or more chronic continuous or episodic health conditions that are expected to last at least 12 months or until the death of the patient; and that place the patient at significant risk of death, acute exacerbation/ decompensation, or functional decline.
Revised code 10021 describes fine needle aspiration of an initial lesion, without imaging guidance, and four new codes (10004-10007) report fine needle aspiration of an initial lesion by various imaging modalities (ultrasound, fluoroscopy, CT and MRI). Add-on codes 10008-10012 report fine needle aspiration for each additional lesion targeted, beyond the first, according to the imaging guidance used (if any).
Six new codes (11002-11007) describe skin biopsy by various technique.
- Two codes for tangential biopsy: one for a biopsy of a single lesion, and the second (add-on) code describes each additional lesion biopsied, beyond the first. A tangential biopsy is performed with a sharp blade to remove a sample of epidermal tissue (which may include some underlying dermis).
- Two codes for punch biopsy, which requires a punch tool to remove a full-thickness cylindrical sample of skin: one for biopsy of a single lesion, and the second (an add-on code) for each additional lesion biopsied.
- Two for incisional biopsy, which is performed using a sharp blade to remove a full-thickness sample of tissue via a vertical incision or wedge, penetrating deep to the dermis, into the subcutaneous space: one for biopsy of an initial lesion, the second (add-on code) for additional lesions sampled by incisional biopsy.
Add-on codes now report osteoarticular (20932), hemicortical (partial) intercalary (20933) and complete intercalary (20934) allografts, which are reported in addition to tumor removal procedures.
New code 27369 describes an injection procedure for contrast knee arthrography or contrast-enhanced CT/MRI knee arthrography.
New codes describe implantation (33274) and removal (33275) of permanent leadless pacemakers, plus implantation (33285) and removal (33286) of subcutaneous cardiac rhythm monitor, and implantation of a wireless pulmonary artery pressure sensor (33289).
Code 33440 now describes the Ross-Konno procedure (a method of aortic valve replacement). Add-on code 33866 reports an aortic hemiarch graft, in addition to ascending aortic graft (33860, 33863, 33864), when ascending aortic disease involves the aortic arch.
Codes 36568 (younger than age 5) and 36569 (age 5 and older) are revised to report peripherally inserted central venous catheter (PICC) placement without subcutaneous port or pump, and without imaging guidance. Two new codes (one for a patient younger than age 5, the second for age 5 and older) are added to describe PICC line procedures that bundle imaging guidance, image documentation, and all associated radiological supervision and interpretation. If confirmation of the catheter tip location is not performed, you must indicate a reduced service, per CPT®.
Hemic and Lymphatic System
Added code 38531 describes open biopsy or excision of inguinofemoral lymph node(s), which are located near the groin.
Code 43760 is deleted and replaced by 43762 for percutaneous replacement of gastrostomy tube without imaging or endoscopy, and 43763 for percutaneous replacement of gastrostomy tube with removal when performed without imaging or endoscopy.
Code 50395 is deleted and replaced: 50436 describes enlargement of an existing percutaneous tract to the renal collecting system to allow the use of instruments used during an endourologic procedure, while 50437 reports the same service with the addition of new access into the renal collecting system during the same session, if there is no pre-existing tract.
New code 53854 describes the use of radiofrequency energy to create steam, which is used in turn to to destroy targeted, obstructive prostate tissue cells.
Several codes are deleted due to low utilization. To report procedures for which there is no dedicated Category I or Category III code, revert back to a Category I unlisted procedure code.
Added codes 76978-76979 report ultrasound procedures that use dynamic microbubble-sonographic contrast with targeted ultrasound to evaluation lesions.
Three new codes report ultrasound elastography (USE):
- 76981, parenchyma (i.e., the functional parts of a body organ)
- 76982, first target lesion
- 76983, an add-on code, for each additional target lesion (reported a maximum of two units per session)
Existing breast MRI codes 77058 and 77059 are deleted and replaced by four new codes:
- 77046: Unilateral (MRI imaging of one breast) without contrast
- 77048: Unilateral (MRI imaging of one breast) with contrast
- 77047: Bilateral (MRI imaging of both breasts) without contrast
- 77049: Bilateral (MRI imaging of both breasts) with contrast
Pathology and Laboratory
Due to frequent use, many services previously classified within “Tier 2” molecular pathology codes are now described using stand-alone “Tier 1” codes (examples include 81171-81172 and 81173-81183).
BRCA1 and BRCA2 testing codes (e.g., hereditary breast cancer) are revised due to changes in clinical practice and to standardize molecular pathology code structure.
A new vaccine product for influenza virus gains a code, 90689.
Code 92275 is deleted and replaced by three new codes for electroretinography (ERG), “including full field (flash and flicker) (92273) for a global response of photoreceptors of the retina, multifocal (92274) for photoreceptors in multiple separate locations in the retina including the macula, and pattern (0509T) for retinal ganglion cells,” per CPT® guidelines.
Added code 95836 describes services related to electrocorticogram (ECoG) from electrodes implanted on or in the brain, to include unattended recording with storage for review, with interpretation during a 30-day period.
New codes 95976-95984 describe services related to implanted neurostimulator pulse generator/transmitter.
A new subsection for adaptive behavior services (ABS) is added, including behavior identification assessment (97151 and 97152), adaptive behavior treatment by protocol (97153 and 97154), adaptive behavior treatment with protocol modification (97155), family adaptive behavior treatment guidance (97156 and 97157), and group adaptive behavior treatment with protocol modification (97158).
Two new codes describe developmental test administration (96112, first hour, and 96113, each additional 30 minutes). These services must include an interpretation and report by a qualified provider.
Codes 96130, 96131, 96136, 96137, 96138, 96139 and 96146 are added to report time-based, psychological testing evaluation and administration and scoring services.
Category III Codes
Category III codes report emerging technologies to allow for data tracking. If a Category III code is available, you must use it in place of a Category I unlisted procedure code.
New Cat. III codes 0512T and 0513T report extracorporeal shock wave therapy (ESWT), a non-surgical treatment that involves the delivery of shock waves to reduce pain and promote healing. Existing codes 0101T and 28890 report ESWT to the musculoskeletal system and plantar fascia, respectively.
Revised code 0335T describes extra-osseous (lateral aspect) implantation of a subtalar implant to stabilize a talotarsal displacement (partial dislocation of the ankle bone on the heel bone). New codes describe removal (0510T), and removal and reinsertion (0511T), of sinus tarsi implant.
Codes 0515T-0523T are added to report services related to wireless cardiac stimulator system (e.g., insertion of various components, device programming, etc.), which provides biventricular pacing of the heart using a previously implanted pacemaker or defibrillator and a wireless electrode implanted on the endocardium of the left ventricle.
Similarly, new codes 0525T-0532T describe services related to an intracardiac ischemia monitoring system, an implantable electrogram device that records cardiac data and detects ischemic events by way of an intracardiac lead in the right ventricular apex. The system provides a warning if it detects an impending acute ischemic event, to help reduce the time from ischemic event onset to the onset of care.
Codes 0533T-0536T describe services related to Personal Kinetograph™ (PKG™). A PKG is a passive, wearable devices that continuously measure and track the movements of patients with Parkinson’s disease. The resulting data is used to manage care and to treat symptoms such as bradykinesia, dyskinesia and tremor.
Two codes now report magnetocardiography (MCG), a non-invasive technique to measure and map magnetic fields produced by electrical activity in the heart. MCG is more sensitive than an ECG to weak cardiac signals, and thus may be beneficial when diagnosing ischemic heart disease (IHD).
Code 0541T describes the technical portion of an MCG study (e.g., performance of the test using equipment as specified in the code descriptor), while 0542T describes the related interpretation and report (i.e., the professional portion of the service).
More to Learn
The above is only a summary of changes to CPT 2019. For a complete rundown of the new, revised, and deleted codes and guidelines, see AAPC’s comprehensive 2019 CPT Coding Updates Virtual Workshop, which is available on demand.