CPT^® coding changes

2020 coding changes

For a summary of this year’s CPT^® coding changes download the handout and watch the webinar here.

We provide a review of CPT^® and CMS changes annually when updates are released. If needed for reference, changes from previous years are archived below.

Previous years

2018 coding changes

If you need detailed information about CPT^® coding changes, there are two good sources.

• One costs a lot of money…attending the AMA’s CPT^® course in November of each year.
• For less money, you can buy a copy of CPT^® 2018 Changes: An Insider’s View. You can buy this book every year.

That is what I do, and I’m going to summarize what I’ve learned in this article. The book I am referencing is 244 pages long. This article, will provide a high level overview.

Get your CPT^® book out as your read this article!

E/M section | CPT^® changes

• The observation code descriptions got a slight change from “admission to observation status” to “outpatient hospital observation status.” This emphasizes the observation means that the patient is in an outpatient status.
• The domiciliary, rest home, or custodial care codes now include “Group home, custodial care and intermediate care facilities.”
• The anticoagulation management codes 99363 and 99364 were deleted. There are new codes in the medicine chapter related to anticoagulant management. I will get to those later.
• The text in the neonatal and pediatric critical care codes is now explicit about when to use 99291 and 99292. The neonatal and pediatric critical care codes are per day codes. One of physician bills those services for the care of the patient for a calendar day, a 24 hour period.  Physicians of the same specialty in the same group are paid is if they were one physician. CPT^® now explicitly says that a physician in the same group who is billing the neonatal and pediatric critical care codes may not also Bill 99291 and 99292.  Physicians of other specialties for providing critical care may bill 99291 and 99292 for a critically ill neonate or child.

Behavioral health and cognitive assessment | CPT^® changes

In 2017 CMS developed HCPCS codes for behavioral health collaborative care management and assessment of the patient with cognitive impairments. In 2018,  these are replaced by CPT^® codes.  I have written about these codes in separate articles. Links to those articles are at the end of this post.

99483 replaces HCPCS code G0505

99492 replaces HCPCS code G0502

99493 replaces HCPCS code G0503

+99494 replaces HCPCS code G0504

99484 replaces HCPCS code G0507

Anesthesia | New CPT^® codes

There are five new codes for anesthesia services for upper GI procedures, lower intestinal procedures, screening colonoscopy and a combined code.  Check your CPT^® book for the handful of deleted anesthesia codes.

00731 Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified

00732     ERCP

00811 Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum, not other specified

00812    screening colonoscopy

00813 Anesthesia for combined upper and lower GI endoscopic procedures, endoscope introduced both proximal and distal to the duodenum

Surgery | CPT^® code changes

Most of the changes to the surgery section (10000—69990) are in vascular codes.  But there are a scattering of changes in other chapters.

Two new skin codes

15730 Midface flap (ie, zygomaticofacial flap)with preservation of vascular pedicle (s)

15733 Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie. buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)

+19294 Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy.  Use 19294 with 19301, 19302

There is a parenthetical notes added to some mastectomy codes to preclude reporting intraoperative placement of clip(s) separately

Musculoskeletal | new CPT^® code

+20939 Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision

This is an add on code to a list of about 20 codes.  Look in your CPT^® book for the listing. 20939 may be reported bilaterally.

ENT | CPT^® code changes

There are new codes for nasal/sinus endoscopy and revisions to codes 31254, 31255 and 31276.

New codes

31241 Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine artery

31253  Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed

31257  total (anterior and posterior), including sphenoidotom

31259  total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus

31298  Nasal/sinus endoscopy, surgical; with dilation of frontal and sphenoid sinus ostia (eg, balloon dilation)

In addition, there is new commentary about the use of modifier 52 and 53 in the CPT^® book, at the start of the Endoscopy section.

It states that when performing 31231—31235, if not all of the components are performed because they are not clinically relevant or the clinician is unable (anatomy, technical difficult) and a repeat procedure is not scheduled, report the endoscopy with modifier 52.  If a repeat procedure is scheduled to perform all of the components report the endoscopy with modifier 53.

Pulmonary | CPT^® code changes

Code 31646 was revised to add the words “same hospital stay.”  31646 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital stay

There is a new code to report ablation of pulmonary tumors via cryoablation; 32998 now includes imaging guidance.

32994   Method of ablation: ablation therapy by cryoablation differentiated from radiofrequency ablation therapy

32998  Ablation therapy for reduction or eradication of 1 or more pulmonary tumor(s) including pleura or chest wall when involved by tumor extension, percutaneous, including imaging guidance when performed, unilateral; radiofrequency

There are three new codes for heart/lung transplants.  These were Category III codes in 2017 and were revised to reflect current clinical practice.  See 33927,  33928 and +33929.

Endovascular | CPT^® code changes

The EVAR (endovascular aneurysm repair). section got a major overhaul.

The new codes bundle related services into repair, including pre-procedure sizing and device selection, non-selective catheterizations and radiological supervision and interpretation.

• There are sixteen new codes, eight deleted codes and four revised codes.
• The new codes are in the series 34701—34812. These CPT^® codes have more detailed descriptions of vessels and what is included in the procedure. They are based on vascular anatomy and distinguish between repair for rupture and repair for other than rupture.
• Some exposure codes are changed from primary to add on codes.
• There is a new code for anchoring a graft and a code for using a large catheter.
• Vascular practices: read the CPT^® editorial comments, study the codes and contact the Society for Vascular Surgeons (vascular.org) with questions.

The codes for injection of sclerosant for sclerotherapy were revised for 2018.  (Look at codes starting with 36468.

• There are out of sequence codes in this series.
• There are many parenthetical comments regarding when imaging guidance may be reported, if the service may be reported more than once per extremity and what codes may not be reported.

CPT^® also provides a definition of compounding.

“Compounding is a practice in which a qualified health care professional (eg, pharmacist, physician) combines, mixes or alters ingredients of a drug to create a medication tailored to the needs of an individual patient.”

When performed in the office, all required supplies and equipment, and application of compression bandages and stockings are included in the fee for the procedure and should not be reported separately.

There are new codes (out of sequence) for endovenous ablation therapy.  See 36482 and +36483.

Bone marrow | CPT^® changes

There are two revised codes and one new code.   And, don’t forget the add-on code 20939 in the musculoskeletal section for bone marrow aspiration during spine surgery.

Revised codes

38220 Diagnostic bone marrow; aspiration (s)

38221 Diagnostic bone marrow biopsy (ies)

When aspiration is both diagnostic and biopsy, report new code

New codes

38222 Diagnostic bone marrow biopsy(ies) and aspiration(s)

Lymph nodes | New CPT^® code

New code

38573 laparoscopy, Surgical with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omenectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed. This code may not be reported with a long list of other procedures.  Take a look at the CPT^® book for the list.

Digestive system | New CPT^® codes and changes

There are three new codes in the digestive system for esophagectomy

• via an open and laparoscopic approach,
• via a thoracoscopic and laparoscopic approach and
• via a thoracosocpic, laparoscopic and open approach.

See codes 43286, 43287 and 43288.  These codes have work RVUs of 55, 63 and 66 respectively.  The first allows for a co-surgeon (per Medicare, of a different specialty) when documentation supports the need.   Co-surgeons are allowed for 43287 and 43288 (of a different specialty, per Medicare).

GU, male | CPT^® changes

Ligation of vas deferens, 55450 was deleted and users are instructed to use 55250, vasectomy instead.

New code

55874  Transperineal placement of biodegradable material, peri- prostatic, single or multiple injection(s), including image guidance, when performed.

GU, female | CPT^® changes

Three codes, 57240 anterior colporrhaphy, 57260, combined anteroposterior colporrhaphy and 57265, with enterocele repair now have “includes cystourethroscopy, when performed” in their definition.

New code

58575  Laparoscopy, surgical, total hysterectomy for resection of malignancy (tumor debulking), with omentectomy including salpingo-oophorectomy, unilateral or bilateral, when performed.

Nervous system | New CPT^® codes

Two new codes

64912  Nerve repair; with nerve allograft, each nerve, first strand (cable)

+64913  with nerve allograft, each additional strand (List separately in addition to code for primary procedure

Chest x-rays and abdominal x-rays were deleted and new codes added. Read about those changes in the article 2018 Radiology CPT^® code changes.

Pathology | CPT^® code revisions

The drug testing codes were revised, 80305, 80306 and 80307 to conform to the CPT^® format, without any change in meaning.

There are additional codes for Tier 1 and Tier 2 molecular pathology and new codes for mRNA expression testing.

Medicine section | CPT^® code changes

Vaccines

Vaccines are updated every six months.  In the 2018 book, there are new vaccine codes.

90756 Influenza virus vaccine, quadrivalent [ccIIV4], derived from cell cultures, subunit, antibiotic free, 0.5 mL dosage, for intramuscular use

90682 Influenza virus vaccine, quadrivalent [RIV4], derived from recombinant DNA, hemagglutinin [HA] protein only, preservative and antibiotic free, for intramuscular use

90587 Dengue vaccine, quadrivalent, live, 3 dose schedule, for subcutaneous use

90750 Zoster (shingles) vaccine (HZV), live for subcutaneous injection

Anticoagulation management

There are two new codes for caring for patients who are on anti-coagulation treatment.

The first is for training a patient/caregiver to do home INR monitoring. The second is for managing the patient. There is an article on CodingIntel that describes these.

Pulmonary

There are two new codes in the pulmonary section

94617  Exercise test for bronchospasm, including pre- and post- spirometry, electrocardiographic recording(s), and pulse oximetry

Includes pulmonary tests and electrocardiographic recordings

94618  Pulmonary stress testing (eg, 6-minute walk test), including measurement of heart rate, oximetry, and oxygen titration, when performed

Includes measurements of heart rate and oxygen levels (oximetry and oxygen titration), when performed

94620 was deleted, and 94621, cardiopulmonary testing, was revised.  If your practice performs cardiopulmonary testing, look at the parenthetical notes after code 94621. 94621 may not be reported with EKG, rhythm ECG, stress testing and some pulmonary function tests.

Ambulatory glucose testing

Ambulatory glucose testing got a new code and a revised code, to distinguish between equipment ownership.  Use 95250 when the physician owns the equipment.  95251 is used for the analysis, interpretation and report, and may not be reported more than once monthly.

There is a new code, 95249 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook- up, calibration of monitor, patient training, and printout of recording. Use 95249 when the equipment is not owned by the physician.

Photodynamic therapy

95930, visual evoked potential testing was revised, as was 96567 photodynamic therapy.

There are codes for non-surgical treatment of skin lesions.  There are two new codes.

96573  Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day

96574 Debridement of premalignant hyperkeratotic lesion(s) (ie, targeted curettage, abrasion) followed with photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day

Physical rehab

In the physical rehab section, there is a new code for interventions that focus on cognitive function.  Report this only once per day. 97532 was deleted.

97127  Therapeutic interventions that focus on cognitive function (eg, attention, memory, reasoning, executive function, problem solving, and/or pragmatic functioning) and compensatory strategies to manage the performance of an activity (eg, managing time or schedules, initiating, organizing and sequencing tasks), direct (one-on-one) patient contact.  This code has a status indicator of I (not valid for Medicare purposes) in the Medicare fee schedule, and no RVUs.

Orthotics | CPT^® code revisions

Two orthotics codes were revised to include the initial encounter, 97760 and 97761.

New code

97763  Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes, which may not be reported with 97760 or 97761.  97762 was deleted.

This is an overview | See these additional resources:

For details, look in your CPT^® book or buy a copy of CPT^® 2018 Changes: An Insider’s View.

Reviewed, Betsy Nicoletti 10/12/2018

More articles about CPT^® changes

Behavioral Health Links:

Care Management for Behavioral Health Conditions

Care Management for Behavioral Health Conditions | HCPCS to CPT^® for 2018

Collaboration of Care Model for Behavioral Health Integration (CoCM.BHI)

CPT^® code 99483: Cognitive assessment and care plan services

Psychiatric Collaborative Care Management Services 99492, 99493, 99494

•  Medicare fee schedule
•  Bundling and NCCI
•  Initial evaluations prior to minor surgery
•  E/M and procedure same day
•  Initial evaluations prior to major surgery
•  Pre op evaluations
•  Post op evaluations
•  Modifiers
•  Multiple Procedures

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