Some 2020 CPT® and HCPCS Code Changes

by Ronda Tews, CPC, CHC, CCS-P | Nov 25, 2019 |

With 394 codes changes in the 2020 CPT code set, here’s a quick reference guide

 

This blog was originally published on January 30, 2018 and was updated on November 25, 2019 to reflect coding changes. 

As we head into 2020, there are 394 code changes in the 2020 CPT code set, including 248 new codes, 71 deletions and 75 revisions. Many of the changes were sparked by recent advances in healthcare technology, including new digital communication tools such as patient portals and e-visits as well as at-home blood pressure monitoring tools. With increased access to care right in a patient’s home, I predict we will continue to see more codes to accommodate the changing health tech landscape for years to come.

A notable item is the revision of the Intermediate and Complex Repair code descriptions that could affect any specialty doing a closure.

These new codes will go into effect starting January 1, 2020. Below you will find new, revised and deleted CPT codes for various medical specialties that will be accessible in our electronic health (EHR) systems EMA® and gGastro®.

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New CPT Codes for 2020 – All Specialties

CodeDescription
98970Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
98972Qualified nonphysician health care professional online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes
99421Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
99422Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
99423Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes

Deleted CPT Codes for 2020 – All Specialties

CodeDescription
98969Online assessment and management service provided by a qualified nonphysician health care professional to an established patient or guardian, not originating from a related assessment and management service provided within the previous 7 days, using the Internet or similar electronic communications network
99444Online evaluation and management service provided by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient or guardian, not originating from a related E/M service provided within the previous 7 days, using the Internet or similar electronic communications network

New Dermatology CPT Codes for 2020

CodeDescription
15769Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia)
15771Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate
15772Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure)
15773Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate
15774Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure)
80230Infliximab
80285Voriconazole

New Ophthalmology CPT Codes for 2020

CodeDescription
0563TEvacuation of meibomian glands, using heat delivered through wearable, open-eye eyelid treatment devices and manual gland expression, bilateral
66987Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with endoscopic cyclophotocoagulation
66988Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with endoscopic cyclophotocoagulation
92201Ophthalmoscopy, extended; with retinal drawing and scleral depression of peripheral retinal disease (eg, for retinal tear, retinal detachment, retinal tumor) with interpretation and report, unilateral or bilateral
92202Ophthalmoscopy, extended; with drawing of optic nerve or macula (eg, for glaucoma, macular pathology, tumor) with interpretation and report, unilateral or bilateral
92549Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (MCT) and adaptation test (ADT)

 

Revised Ophthalmology CPT Codes for 2020

CodeDescription
0402TCollagen cross-linking of cornea, including removal of the corneal epithelium and intraoperative pachymetry, when performed (Report medication separately)
2022FDilated retinal eye exam with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM)
2024F7 standard field stereoscopic retinal photos with interpretation by an ophthalmologist or optometrist documented and reviewed; with evidence of retinopathy (DM)
2026FEye imaging validated to match diagnosis from 7 standard field stereoscopic retinal photos results documented and reviewed; with evidence of retinopathy (DM)
66711Ciliary body destruction; cyclophotocoagulation, endoscopic, without concomitant removal of crystalline lens
66982Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; without endoscopic cyclophotocoagulation
66984Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); without endoscopic cyclophotocoagulation
92548Computerized dynamic posturography sensory organization test (CDP-SOT), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report

Deleted Ophthalmology CPT Codes for 2020

CodeDescription
0341TQuantitative pupillometry with interpretation and report, unilateral or bilateral
0380TComputer-aided animation and analysis of time series retinal images for the monitoring of disease progression, unilateral or bilateral, with interpretation and report
92225Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; initial
92226Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment, melanoma), with interpretation and report; subsequent

New Orthopedics CPT Codes for 2020

CodeDescription
0565TAutologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation
0566TAutologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral
20560Needle insertion(s) without injection(s); 1 or 2 muscle(s)
20561Needle insertion(s) without injection(s); 3 or more muscles
20700Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)
20701Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)
20702Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)
20703Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)
20704Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)
20705Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)

Revised Orthopedics CPT Codes for 2020

CodeDescription
64400Injection(s), anesthetic agent(s) and/or steroid; trigeminal nerve, each branch (ie, ophthalmic, maxillary, mandibular)
64405Injection(s), anesthetic agent(s) and/or steroid; greater occipital nerve
64408Injection(s), anesthetic agent(s) and/or steroid; vagus nerve
64415Injection(s), anesthetic agent(s) and/or steroid; brachial plexus
64416Injection(s), anesthetic agent(s) and/or steroid; brachial plexus, continuous infusion by catheter (including catheter placement)
64417Injection(s), anesthetic agent(s) and/or steroid; axillary nerve
64418Injection(s), anesthetic agent(s) and/or steroid; suprascapular nerve
64420Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, single level
64421Injection(s), anesthetic agent(s) and/or steroid; intercostal nerve, each additional level (List separately in addition to code for primary procedure)
64425Injection(s), anesthetic agent(s) and/or steroid; ilioinguinal, iliohypogastric nerves
64430Injection(s), anesthetic agent(s) and/or steroid; pudendal nerve
64435Injection(s), anesthetic agent(s) and/or steroid; paracervical (uterine) nerve
64445Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve
64446Injection(s), anesthetic agent(s) and/or steroid; sciatic nerve, continuous infusion by catheter (including catheter placement)
64447Injection(s), anesthetic agent(s) and/or steroid; femoral nerve
64448Injection(s), anesthetic agent(s) and/or steroid; femoral nerve, continuous infusion by catheter (including catheter placement)
64449Injection(s), anesthetic agent(s) and/or steroid; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement)
64450Injection(s), anesthetic agent(s) and/or steroid; other peripheral nerve or branch

Deleted Orthopedics CPT Codes for 2020

CodeDescription
0375TTotal disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection), cervical, three or more levels
64402Injection, anesthetic agent; facial nerve
64410Injection, anesthetic agent; phrenic nerve
64413Injection, anesthetic agent; cervical plexus
78320Bone and/or joint imaging; tomographic (SPECT)
95831Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk
95832Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side
95833Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands
95834Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands

New Otolaryngology CPT Codes for 2020

CodeDescription
0583TTympanostomy (requiring insertion of ventilating tube), using an automated tube delivery system, iontophoresis local anesthesia

Revised Otolaryngology CPT Codes for 2020

CodeDescription
31233Nasal/sinus endoscopy, diagnostic; with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)
31235Nasal/sinus endoscopy, diagnostic; with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)
31292Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wall
31293Nasal/sinus endoscopy, surgical, with orbital decompression; medial and inferior wall
31294Nasal/sinus endoscopy, surgical, with optic nerve decompression
31295Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa
31296Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium
31297Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium
31298Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostia
74210Radiologic examination, pharynx and/or cervical esophagus, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study
74220Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study
74230Radiologic examination, swallowing function, with cineradiography/videoradiography, including scout neck radiograph(s) and delayed image(s), when performed, contrast (eg, barium) study
92626Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); first hour
92627Evaluation of auditory function for surgically implanted device(s) candidacy or postoperative status of a surgically implanted device(s); each additional 15 minutes (List separately in addition to code for primary procedure)
94728Airway resistance by oscillometry

New Plastic Surgery CPT Codes for 2020

CodeDescription
15771Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate
15772Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (List separately in addition to code for primary procedure)
15773Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate
15774Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (List separately in addition to code for primary procedure)

New Gastroenterology CPT Codes for 2020

CodeDescription
46948Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed
49013Preperitoneal pelvic packing for hemorrhage associated with pelvic trauma, including local exploration
49014Re-exploration of pelvic wound with removal of preperitoneal pelvic packing, including repacking, when performed
74221Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study
74248Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination)
80280Vedolizumab
90912Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; initial 15 minutes of one-on-one physician or other qualified health care professional contact with the patient
90913Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry, when performed; each additional 15 minutes of one-on-one physician or other qualified health care professional contact with the patient (List separately in addition to code for primary procedure)

Revised Gastroenterology CPT Codes for 2020

CodeDescription
46945Hemorrhoidectomy, internal, by ligation other than rubber band; single hemorrhoid column/group, without imaging guidance
46946Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more hemorrhoid columns/groups, without imaging guidance
74022Radiologic examination, complete acute abdomen series, including 2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest
74240Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study
74246Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered
74250Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study
74251Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered
74270Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study
74280Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) study, including glucagon, when administered

Deleted Gastroenterology CPT Codes for 2020

CodeDescription
0249TLigation, hemorrhoidal vascular bundle(s), including ultrasound guidance
0377TAnoscopy with directed submucosal injection of bulking agent for fecal incontinence
43401Transection of esophagus with repair, for esophageal varices
74241Radiologic examination, gastrointestinal tract, upper; with or without delayed images, with KUB
74245Radiologic examination, gastrointestinal tract, upper; with small intestine, includes multiple serial images
74247Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed images, with KUB
74249Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through
74260Duodenography, hypotonic
90911Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry

Please note that this is not intended as a comprehensive list but a quick reference guide for some key 2020 CPT and HCPCS codes for the selected medical specialties. Please refer to the American Medical Association (AMA) for all CPT Code Changes.

Sources

Ronda Tews, CPC, CHC, CCS-P

Ronda Tews, CPC, CHC, CCS-P

DIRECTOR OF BILLING AND CODING COMPLIANCE

Ronda Tews, Certified Professional Coder (CPC), Certified in Healthcare Compliance (CHC), and Certified Coding Specialist-Physician (CCS-P), is the director of billing and coding compliance at Modernizing Medicine® and brings over two decades of robust healthcare compliance experience to the organization. In her current role, she develops and manages the billing and coding compliance program for the company. Ronda performs billing and coding compliance audits among other related functions while maintaining knowledge of current regulatory and compliance guidance.

Prior to her time at Modernizing Medicine, Ronda held various roles such as managing provider compliance for a large health plan in Oklahoma and creating a fraud, waste and abuse program. Ronda’s duties have consisted of conducting E/M audits on physicians and mid-level providers, establishing internal auditing and monitoring, as well as teaching basic coding classes to co-workers and providing E/M documentation training to physicians and mid-level providers. She has also implemented compliance education and training programs, managed the Compliance Report Line as well as compliance auditing and monitoring. Ronda also provided coding and documentation education at Missouri State University to the physician assistant students on an annual basis. Ronda has held various roles such as serving as a Quality Improvement analyst and working as a corporate compliance project manager for a large Mid-Western health system.

Ronda founded the Springfield, MO AAPC chapter where she served as the president and treasurer. She remains very active in the industry as she writes articles for industry publications and can be found speaking at conferences. Connect with Ronda on LinkedIn.

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With 335 CPT code changes and other HCPCS changes for 2019, here’s what you need to know.

This blog was originally published on January 30, 2018 and was updated on December 14, 2018 to reflect coding changes.

On September 5, 2018, the American Medical Association (AMA) released the 2019 CPT Code Set in an official press release. With 2019 just around the corner, this is a good time to understand what has changed and how it may affect your medical practice moving forward.

Based on the comments from AMA President Barbara L. McAneny, MD, here are some of the overall themes to note with the changes made for CPT codes as we head into 2019.

  • Many of the changes reflect new technological and scientific advancements
  • Updates reflect the ability to better share information efficiently and accurately across the medical community
  • Overall, CPT codes serve as a common language for reporting current procedures.

These category 1 CPT code changes will take effect for reporting as of January 1, 2019.

Jordan Miller, MD, senior medical director of dermatology, advised that, in 2019 many new CPT and ICD-10 codes will go into effect. The biggest changes for Modernizing Medicine dermatology clients will revolve around these new, specific biopsy codes:

  • Tangential biopsies (11102 and 11103)
  • Punch biopsies (11104 and 11105)
  • Incisional biopsies (11106 and 11107)

While almost all of these changes will occur on the backend in our EHR system, EMA™, and have no impact on the provider’s documentation, users should be aware of a few new plans:

  • If you perform a biopsy for tissue culture there are now two new plans, Shave Biopsy for Tissue Culture and Punch Biopsy for Tissue Culture, which were created to account for these new codes. The old plan, Biopsy for Tissue Culture, will be sunset because it was not specific enough.
  • The new plan Incisional Biopsy will allow you to bill the 11106 and 11107 series of codes. Incisional biopsies are biopsies which sample the full thickness of a lesion without attempting to remove the entire lesion. Incisional biopsy codes also include the layered closure of the wound if required.

Detailed below are some of the 2019 CPT and HCPCS code updates for the respective medical specialties that will be reflected in EMA.

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Dermatology CPT Codes

2018: Dermatology CPT Codes2019: Dermatology CPT Codes
11100 Skin Biopsy Single Lesion11102 Tangential Skin Biopsy Single Lesion
11101 Skin Biopsy Ea Sep/Additional Lesion11103 Tangential Skin Biopsy Ea Sep/Additional Lesion
11104 Punch Skin Biopsy Single Lesion
11105 Punch Skin Biopsy Ea Sep/Additional Lesion
11106 Incisional Skin Biopsy Single Lesion
11107 Incisional Skin Biopsy Ea Sep/Additional Lesion

Dermatology HCPCS Codes

2018: Dermatology HCPCS Codes2019: Dermatology HCPCS Codes
Q4131 EpifixQ4186 Epifix
Q4131 EpicordQ4187 Epicord
Q4172 PuraPlyQ4195 PuraPly
Q4172 PuraPly AMQ4196 PuraPly AM

Ophthalmology CPT Codes

2018: Ophthalmology CPT Codes2019: Ophthalmology CPT Codes
92275 Erg w/ Interpretation & Report0509T Pattern Erg w/Interpretation & Report
92273 Full Field Erg w/ Interpretation & Report
92274 Multifocal Erg w/ Interpretation & Report
11100 Skin Biopsy Single Lesion11102 Tangential Skin Biopsy Single Lesion
11101 Skin Biopsy Ea Sep/Additional Lesion11103 Tangential Skin Biopsy Ea Sep/Additional Lesion
11104 Punch Skin Biopsy Single Lesion
11105 Punch Skin Biopsy Ea Sep/Additional Lesion

Ophthalmology HCPCS Codes

2018: Ophthalmology HCPS Codes2019: Ophthalmology HCPCS Codes
J3490 Photrexa (Riboflavin)J2787 Photrexa (Riboflavin)

Orthopedic and Pain CPT Codes

2018: Orthopedic and Pain CPT Codes2019: Orthopedic and Pain CPT Codes
27370 Injection Knee Arthrography27369 Injection Procedure For Contrast Knee Arthrography Or Contrast Enhanced Ct/Mri Knee Arthrography
No Code in 201899491 Chronic Care Mgmt Svc At Least 30 Min Per Month

Orthopedic and Pain HCPCS Codes

2018: Orthopedic and Pain HCPCS Codes2019: Orthopedic and Pain HCPCS Codes
Q9993 Zilretta, 1 MgJ3304 Zilretta, 1 Mg

Otolaryngology (ENT) CPT Codes

2018: Otolaryngology CPT Codes2019: Otolaryngology CPT Codes
10021 Fine Needle Aspiration w/o Imaging Guidance10021 Fine Needle Aspiration w/o Imaging Guidance; 1st Lesion
10022 Fine Needle Aspiration w/ Imaging Guidance10004 Fine Needle Aspiration w/o Imaging Guidance; Each Additional Lesion
10005 Fine Needle Aspiration w/ Imaging Guidance; 1st Lesion
10006 Fine Needle Aspiration w/ Imaging Guidance; Each Additional Lesion
11100 Skin Biopsy Single Lesion11102 Tangential Skin Biopsy Single Lesion
11101 Skin Biopsy Ea Sep/Additional Lesion11103 Tangential Skin Biopsy Ea Sep/Additional Lesion
11104 Punch Skin Biopsy Single Lesion
11105 Punch Skin Biopsy Ea Sep/Additional Lesion
11106 Incisional Skin Biopsy Single Lesion
11107 Incisional Skin Biopsy Ea Sep/Additional Lesion
No Code in 201899491 Chronic Care Mgmt Svc At Least 30 Min Per Month

Otolaryngology (ENT) HCPCS Codes

2018: Otolaryngology (ENT) Codes2019: Otolaryngology (ENT) Codes
No Code in 2018C9749 - Repair Of Nasal Vestibular Lateral Wall Stenosis With Implant(s)

Plastic Surgery CPT Codes

2018: Plastic Surgery CPT Codes2019: Plastic Surgery CPT Codes
10021 Fine Needle Aspiration w/o Imaging Guidance10021 Fine Needle Aspiration w/o Imaging Guidance; 1st Lesion
10022 Fine Needle Aspiration w/ Imaging Guidance10004 Fine Needle Aspiration w/o Imaging Guidance; Each Additional Lesion
10005 Fine Needle Aspiration w/ Imaging Guidance; 1st Lesion
10006 Fine Needle Aspiration w/ Imaging Guidance; Each Additional Lesion
11100 Skin Biopsy Single Lesion11102 Tangential Skin Biopsy Single Lesion
11101 Skin Biopsy Ea Sep/Additional Lesion11103 Tangential Skin Biopsy Ea Sep/Additional Lesion
11104 Punch Skin Biopsy Single Lesion
11105 Punch Skin Biopsy Ea Sep/Additional Lesion
11106 Incisional Skin Biopsy Single Lesion
11107 Incisional Skin Biopsy Ea Sep/Additional Lesion

 

Gastroenterology CPT Codes

2018: Gastroenterology CPT Codes2019: Gastroenterology CPT Codes
43760 Change Gastrostomy Tube Percutaneous w/o Guidance43762 Replacement Of Gastrostomy Tube, Percutaneous, Includes Removal, When Performed, Without Imaging Or Endoscopic Guidance; Not Requiring Revision Of Gastrostomy Tract
43763 Replacement Of Gastrostomy Tube, Percutaneous, Includes Removal, When Performed, Without Imaging Or Endoscopic Guidance; Not Requiring Revision Of Gastrostomy Tract

Gastroenterology HCPCS Codes

2018: Gastroenterology HCPCS Codes2019: Gastroenterology CPT Code
No Code in 2018Q5103 Injection, Infliximab-dyyb, Biosimilar (Inflectra), 10 Mg
No Code in 2018Q5104 Injection, Infliximab-dyyb, Biosimilar (Renflexis), 10 Mg
No Code in 2018Q5109 Injection, Infliximab-qbtx, Biosimilar (Ixifi), 10 Mg

Urology CPT Codes

2018: Urology CPT Codes2019: Urology CPT Codes
11100 Skin Biopsy Single Lesion11102 Tangential Skin Biopsy Single Lesion
11101 Skin Biopsy Ea Sep/Additional Lesion11103 Tangential Skin Biopsy Ea Sep/Additional Lesion
11104 Punch Skin Biopsy Single Lesion
11105 Punch Skin Biopsy Ea Sep/Additional Lesion
11106 Incisional Skin Biopsy Single Lesion
11107 Incisional Skin Biopsy Ea Sep/Additional Lesion

With Modernizing Medicine’s electronic health record system, EMA helps suggest automated codes based on what the provider documents in a visit to reflect the 2019 CPT and HCPCS changes.

Please note that this is not intended as a comprehensive list but a quick reference guide for some key 2019 CPT and HCPCS codes for the selected medical specialties. Please refer to the American Medical Association (AMA) for all CPT Code Changes.

Sources

  • American Medical Association (AMA). AMA releases 2019 CPT code set. https://www.ama-assn.org/ama-releases-2019-cpt-code-set. Published September 5, 2018. Accessed December 10, 2018.
  • American Medical Association. CPT Changes 2019: An Insider’s View. American Medical Association. Published November 10, 2018. Accessed December 10, 2018.
  • Centers for Medicare & Medicaid Services (CMS), HHS. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations-Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. https://www.federalregister.gov/documents/2018/11/23/2018-24170/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions. Published November 23, 2018. Accessed December 10, 2018.
  • Grider, Deborah. AMA Releases 2019 CPT® Code Set. https://www.icd10monitor.com/ama-releases-2019-cpt-code-set. Published September 10, 2018. Accessed December 10, 2018.
Danielle Zarnowiec, MBA

Danielle Zarnowiec, MBA

Requirements Analyst

Danielle Zarnowiec joined Modernizing Medicine in October 2012 and in her current role she serves as the team lead for EMA’s Medical Coding Engine and RCM’s Intelligent Claims Engine.

Previously, Danielle was the owner and operator of a Revenue Cycle Management (RCM) company specializing in medical coding consulting, revenue cycle management and physician quality reporting.

Danielle earned a bachelor’s degree in business administration from St. Andrews University where she served as captain of the NCAA women’s soccer and tennis teams. She then graduated from Palm Beach Atlantic University with an MBA in international business.

 

 

A Quick Guide to Some Key 2018 CPT Changes

A new year often brings new changes. One such change includes 2018 CPT® codes.

On December 31, 2017, the Modernizing Medicine team updated the smart billing engine in our electronic health record (EHR) systems, EMA™ & gGastro™ to reflect the 2018 CPT changes. Patient visits finalized on or after January 1, 2018, will reflect the 2018 CPT codes on medical billing insurance claims.

There are a total of 314 code changes throughout the 2018 CPT manual:

  • 172 of these CPT codes are new
  • 60 codes are revised
  • 82 codes were deleted

As for the changes, they vary based on specialty.

Dermatology/Plastic Surgery CPT Changes: PDT and Facial Flap Repair

Photodynamic Therapy (PDT) is commonly performed to treat conditions such as actinic keratosis, acne, inflammatory rosacea and other skin diseases.

Two new PDT CPT codes were created, 96573 and 96574, and the existing CPT 96567 was revised. According to the AMA, the rationale behind the change relates to the physician-work component of each CPT RVU (relative value unit). Now the codes reflect the physician identification, application of the photosynthesizing agent and whether the debridement of a hyperkeratotic lesion occurred on the date of service.

Below is the description of the physician-work component included in each code:

  • 96567: “Performed by Nurse, MA or Aesthetician”
  • 96573: “Performed by MD, PA-C or NP”
  • 96574: “Performed by MD, PA-C or NP with Pre-Procedure Debridement of Hyperkeratotic Lesions”

In 2018 we say goodbye to the deleted CPT 15732, a muscle, myocutaneous or fasciocutaneous flap of head and neck. 15732 splits into two new CPT codes to provide clarification on flaps with no named vascular pedicle vs named vascular pedicle.

  • 15730 – “Midface flap without a named vascular pedicle”
  • 15733 – “Muscle, myocutaneous, or fasciocutaneous flap of the head and neck with named vascular pedicle”

Ophthalmology CPT Changes: VEP

When it comes to ophthalmology, the new CPT code 0464T was created to perform Visual Evoked Potential (VEP) testing on glaucoma patients. Consequently the existing CPT code 95930 was revised to exclude glaucoma. No changes were made to 0333T which is used to test visual acuity during computer automated visual acuity screening.

Orthopedics/Interventional Pain/ENT CPT Changes: Chest X-Ray Interpretation

For Orthopedics, Interventional Pain and ENT practices, all nine of the 2017 Chest X-Ray Interpretation CPT codes were deleted and four new codes replaced them in 2018.  

The 2018 CPT codes are as follows:

  • 71045: Chest, single view
  • 71046: Chest, 2 views
  • 71047: Chest, 3 views
  • 71048: Chest, 4 or more views

Specifically for Interventional Pain practices, the International Normalization Management (INR Test) related to anticoagulation management, CPT codes 99363 and 99364 were deleted in 2018 CPT changes. They have split into two codes to differentiate if the management is occurring at home or outpatient.

  • 92792 – “Outpatient”
  • 92793 – “Home”

Gastroenterology CPT Changes: Anesthesia

GI sees big changes in Anesthesia related endoscopic procedures. In 2017 there was only one CPT for upper GI endoscopic procedures, 00740, and only one CPT for lower GI endoscopic procedures, 00810. Both 00740 and 00810 have been deleted in 2018.

The new upper GI codes describe upper endoscopic procedures vs endoscopic retrograde cholangiopancreatography (ERCP). The lower GI procedures differentiate between screening colonoscopies vs diagnostic/therapeutic lower endoscopic procedures. There is also a new code to report when both upper and lower endoscopic procedures are performed in the same session.

Here is a list of the 2018 Anesthesia CPT changes:

  • 00731 – Upper GI – endoscope, proximal to duodenum
  • 00732 – Upper GI – endoscope,  ERCP
  • 00811 – Lower GI – endoscope, distal to duodenum
  • 00812 – Lower GI – endoscope, screening colonoscopy
  • 00812 – Upper and Lower GI – endoscope, both proximal to and distal to the duodenum

ENT CPT Changes: Balloon Sinus Dilation and Endoscopy

The existing balloon sinus dilation CPT codes from 2017 remain the same in 2018, but there is the addition of 31298 for when dilation is performed on the frontal and sphenoid sinus ostia.

There are two new Nasal/sinus endoscopy codes in 2018:

  • 31241 – Nasal/sinus endoscopy with ligation of sphenopalatine artery
  • 31254 – Nasal/sinus endoscopy, surgical with ethmoidectomy; partial

In addition, the 31200 section has many new instruction notes regarding the reporting of codes in conjunction to one another. There are also new modifier guidelines for modifier 52 and modifier 53 on endoscopy codes 31241-31235.

For EMA and gGastro users, the most specific 2018 ICD-10, CPT codes and modifiers will automatically generate medical codes in real time. CMS guidelines have been applied to our smart medical coding engine which can assist with clean claims and faster insurance payment. Overall this can help bring efficiency to your practice.

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Please note that this is not intended as a comprehensive list but a quick reference guide for some key 2018 CPT codes for the selected medical specialties. Please refer to the American Medical Association (AMA) for all CPT Code Changes. Another good source includes CodingAhead.com which lists new CPT codes as well as deleted CPT codes.

Sources

Breaking news: CPT 2018 update delivers 4 new E/M codes, mass revisions and updates. PartBNews. https://pbn.decisionhealth.com/Blogs/Detail.aspx?id=200623. Accessed January 8, 2018.

CPT 2018 Changes: An Insider’s View. American Medical Association. Accessed January 11, 2018.

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